1. South Sudan Integrated Service Delivery Program IMPLEMENTING FACILITY AND COMMUNITY COMPONENTS OF PPH PREVENTION PROGRAM Maryrose Dalaka MCH Supervisor MRDA.

2. South Sudan Integrated Service Delivery Program Table of contents  MRDA’s Mission and Vision statements  Introduction  Project Implementation  Achievements  Challenges  Opportunities  Recommendations 

3. South Sudan Integrated Service Delivery Program MRDA’s Vision and Mission Statements  Vision: To be a leading, transforming, efficient and accountable agency promoting equitable sustainable development and peace in South Sudan.  Mission: To work with needy communities of South Sudan

4. South Sudan Integrated Service Delivery Program Introduction  In 2012, MRDA and MCHIP signed an agreement on the implementation of the PPH prevention pilot project in Mundri East County  The MRDA Board and Management welcomed the project and considered it as a special pilot project for the organisation.  The MRDA Maternal Neonatal & Child Health Officer Mrs Mary Rose Dalaka was selected to lead the project as PPH Community Focal Person.

5. South Sudan Integrated Service Delivery Program Project Implementation guide 1.Selection Process for HHPs 2.Selection Criteria for HHPs 3.Training Methodologies 4.Implementation in health facilities 5.Implementation at community level 6.Supportive supervision and follow-up

6. South Sudan Integrated Service Delivery Program 1. Selection Process for HHPs  The selection of Home Health Promoters (HHPs) was carried out by the PPH focal person in consultation with village health committees, community leaders, church leaders, and the community members.  A total of 135 women from Lozoh, Kedi’ba, Witoh, Minga, and Lakama’di Payams were selected.

7. South Sudan Integrated Service Delivery Program 2. Selection criteria for HHPs  Must be female  Committed to the role of HHP as a volunteer  Should always be readily available in their area of operation  Should be a hard-worker with good communication skills  Should be polite; not easily-angered

8. South Sudan Integrated Service Delivery Program 3. Training Methodologies  Training was conducted for two categories of health workers, namely: i.Home Health Promoters (HHPs) ii.Technical staff in facilities  For the HHPs, training was conducted in five batches from Aug 21 to Nov 30, 2012.  For technical staff training was done in two batches from Oct 31 to Nov 19 2012  IEC Materials (flips cards and training manuals) were used due to low literacy among HHPs  Participatory methods were used.

9. South Sudan Integrated Service Delivery Program 4. Implementation in health facilities  It was done by skilled and unskilled birth attendants  They provided antenatal care to women referred to the facilities by HHPs  They counselled pregnant women and their families on BPCR and PPH prevention  They provided Misoprostol tablets and instructions on their use to women after 8 months of pregnancy

10. South Sudan Integrated Service Delivery Program Implementation in health facilities ( Cont’d)  The skilled birth attendance were Administering oxytocin10 iu IM immediately following delivery [ within 1 minute after ruling out the presence of the second baby for AMTSL.  Unskilled birth attendance use Misoprostol 6oomg also after ruling out the presence of second baby  Massage the uterus.

11. South Sudan Integrated Service Delivery Program Implementation at community level It was done by Home Health Promoters (HHPs) They identified pregnant women in the community and counselled them and their family members on BPCR and PPH prevention They made home visits to pregnant women (at least thrice) 2 times during pregnancy and 1 time after delivery to recover Miso package or unused tablets. They provided Misoprostol tablets and instructions on their use to women after 8 months of pregnancy

12. South Sudan Integrated Service Delivery Program Implementation at community level (Cont’d)  They referred pregnant women to health facilities for antenatal care and delivery.  They maintained the list of women counselled and given Misoprostol.  They made monthly routine visits to health facilities to report on their activities and to review their data.

13. South Sudan Integrated Service Delivery Program 6. Supportive supervision and follow-up At facilities  Checking of ANC records on the register  Checking delivery records on the register  Ensuring continuous availability of the drugs Misoprostol and Oxytocin in the health facilities At Community level  Regular meetings with HHPs for sharing experiences  Regular meetings with village health committees  Follow-up with clients who delivered in the community  Meetings with community leaders

14. South Sudan Integrated Service Delivery Program 6. Supportive supervision and follow-up  At facilities  At Community level  Tracking of medicine (from Juba to Lui on waybill  Lui store to health facilities on store cards  Facilities to HHP on stock cards  HHPs to clients recording the serial number on the reporting forms.  Using health education checklist to supervise the HHPs during counselling

15. South Sudan Integrated Service Delivery Program Achievements  Trained a total of 135 HHPs including 68 TBAs and 67 non-TBAs  There was increase in the number of facility- based deliveries  There was a high level of motivation and dedication among HHPs

16. South Sudan Integrated Service Delivery Program Achievements (Cont’d)  HHPs’ messages on BPCR and PPH prevention appeared to be well understood by pregnant women.  The community gladly embraced this intervention

17. South Sudan Integrated Service Delivery Program Challenges  Low literacy levels of HHPs resulted in slow pace in the learning phase  HHPs had to walk long distances due to scattered settlement patterns in Mundri East  HHPs lacked protective gear like raincoats, gumboots, torches yet the project was implemented during the rainy season  Logistical challenges (1 vehicle for covering 15 health facilities)  Difficulty in movement during the rainy season

18. South Sudan Integrated Service Delivery Program Bad roads during the rainy season

19. South Sudan Integrated Service Delivery Program Opportunities  MRDA’s knowledge has been enriched  Women volunteers and TBAs have shown that they can be relied upon in promotion of RH activities  PHCUs are now considered as centres of delivery unlike in the past  This project has proved that Misoprostol can be used in the country

20. South Sudan Integrated Service Delivery Program There is need to:  Continue PPH program  Construct/organize delivery rooms for facilities with SBAs or community midwives.  Provide protective gear like raincoats, torches, gumboots, etc to HHPs  Purchase another vehicle to help cover the vast terrain more effectively Recommendations

21. South Sudan Integrated Service Delivery Program Thank you for listening!!!!