Republic of South Sudan Reproductive, Maternal, Newborn


Download Republic of South Sudan Reproductive, Maternal, Newborn


Preview text

Republic of South Sudan Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH and N) Strategic Plan
2018 to 2022
September 2018
1

Abbreviations
ACTs AIDS ANC ART AU BEmONC BHI BPHNS CEmONC CHW CMAM CRVS DHIS EID EPI EML EMTCT GBV-IMS GDP GFF HEI HSA HIV

Artemisinin Combination based Therapy Acquired Immune Deficiency Syndrome Antenatal Care Antiretroviral Therapy African Union Basic Emergency Obstetric and Newborn Care Boma Health Initiative Basic Package of Health and Nutrition Services Comprehensive Emergency Obstetric and Newborn Care Community Health Worker Community Management of Acute Malnutrition Civil Registration and Vital Statistics District Health Information Systems Early Infant Diagnosis Expanded Program on Immunization Essential Medicines List Elimination of Mother to Child Transmission of HIV and Syphilis Gender Based Violence- Information Management Systems Gross Domestic Product Global Financing Facility HIV Exposed Infants Health Situational Analysis Human Immunodeficiency Syndrome

2

HMIS HRH HSSP HSWG iCCM iCCMNCI IDPs IMCI IRC IPTp ORS MDGs MIYCN MMR MPDSR MTCT MWH NGO PCR PHC PHCC PHCU PMTCT

Health Information Systems Human Resources for Health Health Sector Strategic Plan Health Sector Working Group Integrated Community Case Management
Integrated Community Case Management of Neonatal and Childhood Illnesses
Internally Displaced Persons Integrated Management of Childhood Illnesses International Rescue Committee Intermittent Preventive Treatment of malaria in Pregnancy Oral Rehydration Therapy Millennium Development Goals Maternal Infant and Young Child Nutrition Maternal Mortality Ratio Maternal and Perinatal Death Surveillance Response Mother to Child Transmission Maternal Waiting Home Non-Governmental Organization Polymerase Chain Reaction Primary Health Care Primary Health Care Centre Primary Health Care Unit Prevention of Mother to Child Transmission of HIV
3

PoC PPH SAM RMNCAH and N SBCC SDG SOPs SRH SSHHS STIs THs TWG UNFPA UNICEF USAID WHO

Protection of Civilians Postpartum Haemorrhage Severe Acute Malnutrition Reproductive, maternal, newborn, child, adolescent Health and Nutrition Social Behavior Change Communication Sustainable Development Goals Standard Operating Procedures Sexual Reproductive Health South Sudan Household Survey Sexually transmitted Infections Teaching Hospital Technical Working Group United Nations Population Fund United Nations Children’s Fund United States Agency for International Development World Health Organization

4

Table of Contents
Abbreviations ......................................................................................................................... 2
List of Figures and Tables ........................................................................................................ 7
Executive Summary ................................................................................................................ 8
Acknowledgements .............................................................................................................. 13
Foreword .............................................................................................................................. 14
1.0. Introduction and Background ........................................................................................ 15
1.1 Country Context ....................................................................................................................................... 15 1.2. Health Service Delivery Structure ............................................................................................................ 16 1.3. Rationale for the RMNCAH Strategy........................................................................................................ 17
2.0. Health status of women, newborns, children and adolescents........................................ 18
2.1. Trends in maternal, newborn and child mortality .................................................................................... 20 2.2. Causes of maternal, newborn and child deaths ....................................................................................... 23 2.3. Reproductive and Adolescent Health Situation .................................................................................. 26 2.4. Coverage of RMNCAH and N Services ...................................................................................................... 27 2.4. Equity in access to RMNCAH and N services............................................................................................. 28
3.0. Bottlenecks in access to and utilisation of high impact RMNCAH and N interventions .... 29
4.0. RMNCAH and N strategy guiding principles.................................................................... 37
5.0. High Impact Interventions by life course......................................................................... 39
a. Pre-pregnancy period ............................................................................................................................ 39 b. Pregnancy Period ................................................................................................................................. 40 c. Child birth, Maternal and Newborn Care Period ............................................................................... 41 d. Infancy and Childhood period ................................................................................................................ 42 f. Adolescence period ..................................................................................................................................... 44 e. Cross cutting interventions .................................................................................................................... 44
6.0. RMNCAH and N Strategy Vision, Goals and Objectives ................................................... 46
6.1. Vision ..................................................................................................................................................... 47 6.2. RMNCAH Strategy Goal and Targets ....................................................................................................... 47 6.3. Overall Objective..................................................................................................................................... 47 6.4. RMNCAH and N Strategy Theory of Change............................................................................................. 47
7.0. Strategic objectives, strategies and key actions................................................................ 1
6.1. Strengthened health systems for effective delivery of high impact and quality RMNCAH and N interventions at all levels ................................................................................................................................. 2 6.2. Enhanced community engagement and partnerships for improved access to and utilisation of high impact and quality RMNCAH and N interventions........................................................................................................ 4 6.3. Improving provision of RMNCAH services in humanitarian and fragile settings ......................................... 6
5

7.0. Financing of the RMNCAH strategy .................................................................................. 8
7.1. Cost of implementing the RMNCAH Strategy ............................................................................................. 8
8.0. Implementation, monitoring and evaluation.................................................................... 9
8.1. Leadership and governance for implementation ................................................................................... 9 8.2. Roles and responsibilities ..................................................................................................................... 10
8.2.1. Directorates of Reproductive Health and Primary Health Care at National level .......................... 10 8.2.2. State Governments .................................................................................................................................. 10 8.2.3. Development partners and other non-state actors.................................................................................. 10 8.2.4. Academic, Professional and regulatory authorities ........................................................................... 11 8.2. Monitoring and evaluation ................................................................................................................... 11
9.0. Annexes ......................................................................................................................... 12
9.1. Detailed Two Year Operational Plan........................................................................................................ 12 9.2. RMNCAH Strategy monitoring and evaluation framework ...................................................................... 90 9.3. Summary of bottlenecks by health systems block .................................................................................. 100
6

List of Figures and Tables List of figures
Figure 1: Map of South Sudan.......................................................................................................... 15 Figure 2: South Sudan health service delivery Structure ................................................................. 16 Figure 3: Trends in maternal mortality ratio ................................................................................... 21 Figure 4: Trends in neonatal mortality rate ..................................................................................... 22 Figure 5: Trends in underfive mortality rate .................................................................................... 23 Figure 6: Leading causes of maternal deaths .................................................................................. 24 Figure 7: Leading causes neonatal deaths ...................................................................................... 25 Figure 8: Causes of underfive deaths ............................................................................................... 25 Figure 9: South Sudan RMNCAH and N Theory of Change ................................................................ 1 List of Tables Table 1: South Sudan demographic indicators at snapshot ............................................................ 16 Table 2: Status on selected RMNCAH Impact indicators................................................................. 19 Table 3: Status of coverage indicators............................................................................................. 19 Table 4: Equity analysis on selected indicators ............................................................................... 29 Table 5: High impact interventions by life course and service delivery level................................... 45 Table 6: Boma Health Initiative RMNCAH and N Package of Interventions ..................................... 4
7

Executive Summary
Background and rationale South Sudan has made some progress, albeit slow, in improving the health of her women, newborns, children and adolescents. Despite this progress, with a maternal mortality ratio of 789 per 10000 live births, neonatal and under-five mortality rate of 39.6 and 93 per 1000 live births respectively and an adolescent birth rate of 292 per 1000 women aged 15- 19 years, South Sudan remains as one of the Countries with the poorest health indicators for women, newborns, children and adolescents. This RMNCAH and N strategic plan is a demonstration of the commitment by Republic of South Sudan to improved health of her women, newborns, children and adolescents.
Bottlenecks to access and utilization of RMNCAH and N high impact interventions Understanding bottlenecks in access to and utilization of high impact interventions for reproductive, maternal, newborn, child and adolescent health services is critical to developing effective interventions for addressing those bottlenecks. As part of the development of this strategic plan, supply side and demand side bottlenecks were identified. These have been clustered around the 6 health systems blocks of: Leadership and governance, health care financing, human resources for health, service delivery, commodities and supplies and health information systems. Additionally, the analysis identified community systems bottlenecks and those related to humanitarian fragile settings of the country. The strategic objectives for the strategic plan are aligned to the three clusters of bottlenecks.
The RMNCAH and N Strategic framework Vision: A South Sudan where no woman, newborn, child and adolescent die from preventable causes and where they live to realize their full potential in health and wellbeing Goal: To accelerate efforts towards ending preventable deaths of women, newborns, children and adolescents and ensure their health and wellbeing The following targets will be used to measure achievement of the goal
a. Reduce maternal mortality ratio from 789 to 600 per 100,000 live births by 2022 b. Reduce neonatal mortality rate from 39.9 to 33 per 1000 live births by 2022 c. Reduce underfive mortality rate from 93 to 75 per 1000 live births by 2022 d. Reduce still birth rate from 30 to 25 per 1000 live births by 2022 e. Reduce adolescence mortality rate from 292 to 195 per 100000 by 2022
Overall strategic objective: Increased access to and utilization of quality high impact RMNCAH and N interventions for all women, newborns, children and adolescents in South Sudan. Strategies and key actions by strategic objectives To achieve the overall strategic objective, this plan will implement a set of targeted and prioritised strategies across the three strategic objectives. The table below presents a summary of the strategies and key actions by the three strategic objectives.

Strategies

Key actions

SO1: Strengthened health systems for effective delivery of high impact RMNCAH interventions

Strategy 6.1.1. Strengthen leadership and governance for effective delivery of

Capacity building in leadership and governance for RMNCAH and N managers Strengthen coordination in the delivery of RMNCAH and N services

8

Strategies RMNCAH and N services

Key actions
Ensure availability of upto date policies, guidelines, SOPS and Job aids for provision of RMNCAH and N services

Strategy 6.1.2: Ensure availability of adequate financing for delivery of high quality RMNCAH and N services
Strategy 6.1.3: Ensure availability of competent RMNCAH cadres at all levels of service delivery as per the norms
Strategy 6.1.4: Ensure all time availability of medicines, commodities, equipment and supplies for delivery of quality RMNCAH interventions
Strategy 6.1.5. Strengthen infrastructural development to ensure availability of evidence based high impact RMNCAH and N interventions
Strategy 6.1.6: Enhance integrated RMNCAH and N service delivery Strategy 6.1.7: Provide priority integrated RMNCAH

Provide integrated supportive supervision for delivery of quality high impact RMNCAH interventions
Strengthen partner alignment and harmonization in the provision of RMNCAH and N services
Increase resource mobilization for delivery of RMNCAH and N services Capacity strengthening in planning, budgeting and accountability mechanisms in delivery of RMNCAH and N services
Development of RMNCAH and N HRH training, development and management plan
Strengthening of health training institutes Recruitment and deployment of critical RMNCAH and N cadres at all levels of health service delivery as per need
Ensure retention and motivation of RMNCAH and N critical cadres Integrate competency based training on high impact RMNCAH interventions into health workers pre-service training programs
Implement competency based in-service training on high impact RMNCAH and N interventions
Implement RMNCAH and N task shifting and task sharing mechanism Strengthen RMNCAH and N regulatory bodies Conduct capacity building in procurement, supply and management of essential RMNCAH and N commodities
Procurement of essential RMNCAH and medicines, commodities, supplies and equipment
Ensure all time availability of blood especially in all CEmONC sites Strengthen RMNCAH equipment maintenance and repair in health facilities especially those providing BEmONC and CEmONC
Conduct renovations/construction in health facilities for provision of high impact RMNCAH and N services
Provide power/green energy infrastructural development in health facilities especially in EmONC facilities
Provision of WASH in health facilities especially those providing EmONC services Construction of staff housing in selected CEmONC and BEmONC sites Build capacity of health workers in provision of integrated RMNCAH and N services
Provide priority integrated RMNCAH and N high impact interventions Adapt the WHO standards for improving quality of maternal and newborn care in health facilities

9

Strategies
and N high impact interventions

Key actions
Establish functional RMNCAH and N responsive quality improvement department/committee at various levels of health service delivery

Implement respectful maternity care in BEmONC and CEmONC site
Institutionalise Maternal and Perinatal death surveillance and response (MPDSR)

Strategy 6.1.8: Ensure a functional emergency referral system

Develop and ensure implementation of emergency referral strategy and guidelines at the various levels of health service delivery
Establish a reliable communication system especially at BEmONC and CEmONC sites

Provide a functional ambulances services at the different levels of health service delivery

Strategy 6.1.9: Strengthen health information systems for effective monitoring and evaluation and improved RMNCAH programming

Provide adequate and quality RMNCAH and N data for routine monitoring decision making
Scale up birth and death registration for women, children and adolescents Implement RMNCAH and N periodic reviews, assessments, surveys and research

SO2: Enhanced community engagement and partnerships for improved access to and utilization of

high impact RMNCAH interventions

Strategy 6.2.1. Strengthen

Develop community based RMNCAH and N guidelines, SOPs, job aides

implementation of

and reporting tools

reproductive, maternal, newborn and adolescent health interventions as per

Capacity building of BHT and community health volunteers in delivery of RMNCAH and N high impact interventions during home visits

the BOMA health initiative

Scale up use of misoprostol for managing PPH for home deliveries
Pilot and scale up community health workers and support implementation of community based pregnancy testing

Support community based distribution of contraceptives through use of CBDs Develop and scale up community based RH services including prevention and management of gender based violence as per the BHI

Support implementation of community based adolescent health services including partnership with other sectors including education

Scale up implementation of iCCM
Ensure facility and community linkages and supportive supervision in the provision of community based RMNCAH and N services

Ensure motivation and retention of community health volunteers

10

Preparing to load PDF file. please wait...

0 of 0
100%
Republic of South Sudan Reproductive, Maternal, Newborn