South Sudan: Juba College of Nursing and Midwifery

Project Goals:
 
To improve quality of and access to professional health care services by imparting the necessary skills through a three-year diploma program in either nursing or midwifery at the first College of Nursing and Midwifery in South Sudan accredited by the Ministry of Higher Education and Juba University, offering a diploma of Registered Nursing and Midwifery Status. The College will contribute to reducing the maternal and child mortality in South Sudan in accordance with Millennium Development Goals (MDGs) 4 and 5.

Project Objectives:

1. Provide model courses in Registered Nursing and Registered Midwifery in the first National Health Training Diploma Institute in South Sudan
2. Provide a curriculum recognized by all ministries associated with education in the Republic of South Sudan (RSS)
3. Provide leading edge skills laboratory and library for the students
4. Provide improved clinical setting for student training
5. Provide highly qualified instructors and tutors for the duration of the three year program
6. Provide an unprecedented model of health care sector capacity building for South Sudan
7. Provide a sustainable solution to South Sudan’s Maternal and Infant Mortality Rate, the former, which is the highest in the world at 2,054/100,000 as per the 2006 South Sudan Household Survey. 

Summary of RMF-sponsored activities carried out during the reporting period under each project objective:
 
Implemented activities in line with RMF sponsored activities and project objectives include:

1. Support to the National Ministry of Health, Republic of South Sudan and project partners in the coordination and implementation of project activities. Also in line with the approved College annual work plan. 
2. Continued facilitation of inter-linkages with UNFPA, MOH, IMC and other stakeholders in ensuring quality assurance in the implementation of both nursing and midwifery curricula in the diploma program.
3. Coordination of RMF activities with other organizations and UN agencies supporting the Juba College of Nursing and Midwifery by participating in meetings and conferences.
4. Continued support of human resources through payment of salaries for national tutors.
5. The two master trainers for our Health eVillages project continued to benefit from the provided tablets preloaded with medical information and materials.
6. Data collection for Maternal Near-Miss Audit in Juba Teaching Hospital successful completed with support of college tutors and college midwifery students.
7. Sponsorship of first, second and third year nursing and midwifery students at the Juba College of Nursing and Midwifery through provision of uniforms, skills laboratory equipment, clinical training equipment, books, stationery and Information Technology (IT) equipment.

Results and/or accomplishments achieved during this reporting period:

1. 14 nursing and 16 midwifery year one students joined the College in July 2015 which ensured continuity of the training.
2. The two college tutors provided with the preloaded tablets are able do quick reference checks during lectures and clinical work hence improving the quality of services delivered by them.
3. The two college tutors continued to supervise and mentor the nurses/midwives provided with HeV preloaded tablets which in turn has improved patient care in the facility as the healthcare professionals are able to do quick reference checks and provide health education using the devices.
4. The four college tutors and some third year midwifery students have done tremendous work on data collection for the Maternal Near-Miss Audit in Juba Teaching Hospital during this quarter; data collection has been successfully completed and data analysis is ongoing.
5. The college tutors trained on Clinical Care of Sexually Assault Survivors continued to disseminate the information to students both in the class and clinical areas.
6. The college students are now getting good support and mentorship from JTH staff and college tutors while in clinical practice following the formation of a joint JCONAM-JTH committee which enhances relationships between JCONAM and JTH administration.
7. Coordination of RMF activities and participation in meetings/workshops together with NGOs and UN agencies supporting JCONAM and other National Health Training Institutes (NHTIs)
8. Prepared and submitted proposal to HeVs for additional classes in JCONAM

Impact this project has on the community (who is benefiting and how):

1. The Diploma in Nursing/Midwifery Curriculum is approved by the Ministry of Health and is being used as a model document alongside the College structures for replication in other states.
2. The Ministry of Health through the support of RMF and other stakeholders is working on replicating the College in other states. This will translate into the continued growth in the number of nursing and midwifery diploma institutes in South Sudan and potentially new Nursing/Midwifery College partnerships for RMF.
3. Stakeholders in nursing and midwifery education and services are undertaking the development of a bridge course for Community/Enrolled Midwives for acceptance into diploma training to complete the course in less than 3 years.
4. It is currently estimated that it will take close to 66 years for South Sudan to establish a professional and sustained capacity to address maternal mortality issues in a region with the highest ratio of 2,054 for every 100,000 live births, as per the MOH. In addition to establishing other diploma institutes in South Sudan, the MOH is working on bilateral agreements with neighboring countries to send out qualified South Sudanese to train as nurses and midwives in order to establish a critical mass in the next 10 years.
5. Several years of experience derived from working with JCONAM and other partners has enabled RMF to develop a vision of increasing its level of support in South Sudan. By virtue of its registration and autonomy, RMF will seek to partner with organizations/agencies, and most importantly, government elements in the areas of health systems strengthening and sustainable economic empowerment as witnessed in its projects in other countries.

Notable project challenges and obstacles:

1. Low number of year one students (30) joined the College in July 2015 as opposed to the set annual College intake of 60; this creates a huge gap in the expected number of professionals the College would have trained in a given period of time. With this new trend it will take many more years to solve the problems of shortage the country is experiencing in the nursing and midwifery workforce.
2. Due to the ongoing conflict particularly in the Greater Upper Nile Region, the University of Upper Nile is relocated to Juba and the Department of Nursing and Midwifery is currently conducting lectures from JCONAM lecture rooms hence forcing JCONAM administration to adjust their lecture sessions to accommodate the growing population in an already limited space.
3. The lack of new commitments from the partners in health for JCONAM is creating many unmet needs for the College.
4. Lack of qualified personnel within the hospital to supervise the students when they are conducting clinical rounds, i.e. the students are occasionally supervised by traditional birth attendants leading to a discrepancy between skills taught and what is witnessed.
5. Lack of a medical plan/insurance for the students with consideration of their exposure to infections and other general illnesses in the workplace
6. Lack of extra-curricular activities for the students to engage in during their free time and weekends, i.e. outdoor sports and games
7. The College lacks critical support and administrative staff, such as a finance officer and an administrator.
8. Limited technical and financial commitment and support to the Ministry of Health by the stakeholders for the review of the diploma nursing curriculum
9. Lack of financial commitment by stakeholders for the construction of an urgently needed classroom block, students’ hostel, tutors’ residence and recreational hall

Project Photos

(L to R) JCONAM student counselling a mother about malaria prevention, the child is recovering well from a malaria infection; JCONAM students administer medication to a child on treatment for malaria and bronchopneumonia; JCONAM year two student monitoring a PG in labour (first stage) in maternity unit

(L to R) Evelyn (L) UNPFA midwife volunteer discussing with JCONAM year two student plan for the mother after SVD; JCONAM year two student examining a neonate for signs of anomalies after delivery; JCONAM student explaining to a mother about home management of malaria after discharging the child

(L to R) JCONAM 1^st year students preparing the trolley before starting administering medication in medical unit of JTH; JCONAM students positively encouraging a woman on treatment for Hepatitis; JCONAM students recording their findings after taking vital signs in the morning in Paediatric unit

(L to R) JCONAM first year students observing how to insert IV cannula; JCONAM student preparing patient’s treatment sheet in Gynaecology unit; JCONAM student counselling an anaemic pregnant woman on importance of proper nutrition 

(L to R) Jubilant JCONAM students around the maternity block; JCONAM students in the campus