South Sudan: Juba Teaching Hospital Support
New Growth and Exciting Opportunities: Q2 2016
July 18, 2016
Summary of Activities
- Continued to provide maintenance for the Antenatal care block following the refurbishment completed during the previous quarter.
- Hired a research consultant to review the final version of the Maternal Near-Miss Audit report; the audit was conducted at Juba Teaching Hospital (refer to detailed Maternal Near-Miss Audit report).
- Continued monitoring and mentorship of healthcare professionals trained on the usage of Health eVillages tablets.
- Continued to support high speed WIFI internet service at the RMF office and Maternity ward.
- Procured and delivered 2 laptop computers for RMF’s Juba coordination office.
- Procured and delivered a photocopier and a multipurpose printer for smooth running of RMF’s main Juba office.
- Co-facilitated (with ADRA, THESO, CEI, SSUHA, and AFOD) the rapid health needs assessment of health facilities in Maridi, Mundri, and Juba counties as a baseline for Health Pooled Fund (HPF2) proposal development (refer to assessment report).
- Procured and provided adequate cleaning materials for the Pediatric department to keep the wards clean.
- Continued to support RMF cleaners attached to the Pediatric department to supplement the few cleaners maintained by the Ministry of Health (MOH).
- Procured and provided protective gear like gumboots for the Pediatric department cleaners.
- Prepared and submitted proposal for improving the Maternity department of Juba Teaching Hospital.
- Prepared and submitted WASH proposal to a private donor aimed at solving the water problems at Juba Teaching Hospital.
- Facilitated and coordinated meetings with the Ministry of Health (MOH), UN agencies, and other partners on how to improve services at Juba Teaching Hospital.
- Facilitated RMF Founder and CEO Dr. Martina Fuchs’ visit to South Sudan.
Improved Grounds and Buildings
The improved/upgraded, well-furnished, well-maintained Antenatal Care Unit (ACU) continued to provide quality antenatal care services for women and men. The ACU also provides a favorable learning environment for students from JCONAM, Juba Health Science Training Institute, Juba School of Nursing, Central Equatoria School of Nursing/Midwifery, the Juba University College of Medicine, and visiting teams. The Maternity Operating Theater continued to provide emergency obstetric services, further improved by the installation of an air conditioning system.
Psycho Trauma Support
There is also general improvement in patient care in all departments at Juba Teaching Hospital (JTH) following the training on psycho trauma support, as most of the healthcare professionals are now able to provide comprehensive healthcare services including identification and management of traumatized patients. Schoolteachers trained in psycho trauma support by RMF continued to provide services for traumatized students, hence improving the general performance and school attendance of children and young adults.
Coordination and Performance
We continued to support high speed WIFI internet service at both the Maternity ward and RMF’s office, providing internet access to doctors, nurses, and RMF’s Juba team. RMF’s Juba-based staff is benefiting from the provided laptop computers, which are helping improve coordination and program performance. This is also facilitating research and improving continuous medical education for healthcare professionals and coordination for RMF’s team.
More Efficient Visits
The two Health eVillages (HeV) master trainers, along with Juba Teaching Hospital’s nurses, midwives, and doctors continued to benefit from the HeV tablets. JTH staff is now able to do quick reference checks, hence improving the quality of care and general services they provide. We collected the monthly report from healthcare professionals on the usage of HeV tablets and patients’ responses to how the application of the tablets influenced their healthcare experience. This is to evaluate the impact of the Health eVillages project (the evaluation is still ongoing).
Growth and Expansion
Prepared and submitted proposals to Health Pooled Fund as a consortium for implementing health and nutrition services in Juba, Maridi, and Mundri counties with RMF expected to run hospitals in those counties. We are diligently following up on the WASH proposal submitted to a private donor. Dr. Martina Fuchs supported the RMF in-country team and strengthened RMF’s collaboration with the Ministry of Health, UN agencies, NGOs, donors, JCONAM, and JTH administrators, thereby opening the way for new opportunities.
Improved Patient Experience
Waiting times in the Antenatal Care Unit have been reduced, since there are now three well-furnished examination rooms compared to only one before the renovation. This has a very positive effect, as women are receiving quality services and encouraging their communities to visit JTH, hence improving the rate of institutional deliveries and overall pregnancy outcomes. These rooms also ensure privacy and encourages women to share their concerns and pregnancy related complications with healthcare providers. This plays a significant role in the overall outcomes of their pregnancies.
Juba Teaching Hospital, the only referral hospital in the whole country of South Sudan, is located in its capital Juba, Central Equatoria State. With an estimated population of 10.16 million basing on annual population growth of 3% from a population census conducted in 2008 and lack of proper functioning primary health care facilities upcountry, many South Sudanese have nowhere to go to but this national referral hospital. Military and police hospitals, if any, are non-functional country wide, forcing soldiers and officers to share the limited facilities with civilians.
Juba Teaching Hospital is directly funded by the central government through the National Ministry of Health, and supported by Real Medicine Foundation, Medical Mission International, UN agencies and other NGOs. Our overarching goal is to improve the quality and sustainability of medical and surgical services provided at Juba Teaching Hospital.
- Improve patient wards and build infrastructure within Juba Teaching Hospital starting with the Pediatric wards.
- Assist in improving conditions for providing health care at Juba Teaching Hospital, including the policies and management of regular and medical waste.
- Rehabilitate and/or purchase new medical equipment.
- Provide basic medical supplies, disposables and pharmaceuticals for the Pediatric Department, complementing those provided by the Ministry of Health.
- Organize on-site clinical training, beginning with general equipment usage.
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Notable Challenges and Obstacles
- As per Ministry of Health orders, the two blocks of the Accident and Emergency (A&E) Department in Juba Teaching Hospital (JTH) are still not occupied following their successful upgrade/ improvement by RMF. Patients are still lying on the floor due to lack of space. The A&E blocks are not serving the purposes stipulated in the improvement proposal and agreed upon by the Ministry of Health in writing, thus hindering patients’ wellbeing.
- The operation theaters in the A&E department are not functional due to lack of equipment. This, in turn, hinders the performance of minor surgeries since the main operating theater is always fully booked.
- Power instability at Juba Teaching Hospital hinders effective and efficient service delivery, especially at night. The lack of reliable electricity has contributed significantly to the maternal and under-5 mortality rates in Juba Teaching Hospital (JTH).
- Frequent interruption of running water in the hospital compromises cleaning and effective infection control measures, as well as preventing normal functioning of the operating theaters and labor suite.
- Irregular and inadequate supplies of pharmaceuticals, consumables, and laboratory reagents forces patients to buy most of the needed supplies from private pharmacies. Due to poverty and rising inflation (the inflation rate has risen to approximately 660%), most people are not able to afford modern medicines, which increases patient mortality at Juba Teaching Hospital (JTH).
- The Ministry of Health (MOH) lacks commitment in initiating a stabilization center for the management of Severe Acute Malnourished (SAM) children with medical complications.
Plans for the next period
- Continue to implement RMF’s annual work plan, guided by our MOU with the Ministry of Health (MOH).
- Follow up on the WASH proposal for improving Juba Teaching Hospital’s water and sanitation system.
- Follow up on the proposal for further improvements to the Maternity department.
- Follow up on the proposal for healthcare/nutrition implementation with HPF.
- Continue advocacy with JTH administration, MOH, and the health cluster to make the two fully renovated and upgraded A&E department blocks available to patients.
- Discuss (with the MOH) the possibility of setting up a stabilization center in Juba Teaching Hospital for the management of Severe Acute Malnourished (SAM) children with medical complications.
- Discuss (with the MOH) the possibility of receiving essential medicines from Direct Relief International to supplement those provided by the MOH.
- Continue to monitor the impact of the Health eVillages tablets.
- Finalize and publish the Maternal Near-Miss Audit report.
- Continue to rehabilitate the equipment set at Juba Teaching Hospital, with focus on the Pediatric department.
- Continue to provide basic medical supplies, disposables, and pharmaceuticals for Juba Teaching Hospital (JTH), especially the Pediatric department, complementing those provided by the Ministry of Health.
- Continue to organize on-site clinical training.
- Continue trainings on Respectful Health Care and Respectful Maternity Care, and continue to monitor and evaluate the impact of RMF’s Respectful Maternity Care Project through continued supervision guided by RMF’s RMC supervisory checklist, specifically developed for this purpose.