South Sudan: RMF UNICEF Malnutrition Treatment and Prevention Program Jonglei State

Treatment and Prevention of Acute Malnutrition in Jonglei & Greater Pibor Administrative Area, Republic of South Sudan

Photo: RMF nutrition nurse measuring the MUAC of a child during screening

Photos: (Left) RMF staff administering appetite test in the field (Right) RMF staff with children in Kisiongora

Project Goals:

The overall goal of this project is to reduce the GAM rate to acceptable levels of less than 15% in each of the Payams assigned to RMF. This will be in line with standards set by the South Sudan National Nutrition Program.

Project Objectives:

1. To provide lifesaving nutrition services for acutely malnourished children (boys and girls) less than 5 years of age and pregnant and lactating women in targeted counties.
2. To prevent malnutrition in early childhood through promotion of improved infant and young child feeding, care giving and care seeking practices at the facility, community and family level.
3. To prevent and treat micronutrient deficiency disorders in children and women through provision of multiple micronutrient supplementation, Vitamin A and deworming campaigns in the assigned areas.
4. To strengthen the capacity of the County Health Department (CHD) and provide appropriate resources for the initiation and integration of nutrition services into existing Primary Health Care as well as linking nutrition interventions in the health system in the targeted counties.

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. Procured, installed and furnished office space on Juba Teaching Hospital grounds for the nutrition team and storage facility for keeping the nutrition supplies before airlifting to the areas of intervention.
2. Upgraded internet bandwidth to supply sufficient internet services for the entire RMF team.
3. Facilitated and signed Memorandum of Understanding (MOU) with Jonglei State Ministry of Health and with Greater Pibor Administrative Area.
4. Conducted rapid needs assessments in Gorwai, Kuach-deng Payams in Ayod County and Boma County in Greater Pibor Administrative Area to pave ways for establishment of nutrition programs in those areas.
5. Procured all the necessary equipments for establishing OTPs and essential foodstuffs and non food items for the nutrition teams.
6. Procured and delivered communication devices (Thuraya phones) for our field staffs to enhance proper coordination since internet and telephone services provided in the major towns/security stable locations are not available in all our intervention areas which are designated as hard to reach places and also majorly affected by the ongoing conflict which erupted in mid-December 2013.
7. Chartered commercial and UNHAS aircrafts which delivered nutrition supplies, OTP equipments, foodstuffs and the trained nutrition staffs to Mogok and Kuach-deng Payams in Ayod County and Maruwo and Kisiongora in Boma County.
8. Facilitated and established four functional OTPs, two each in Boma and Ayod Counties, respectively, providing adequate CMAM and IYCF services.
9. Conducted CMAM and IYCF training for our 10 nutrition nurses, the training took place in Juba before deployment of the team to the various field locations.
10. Facilitated the coming of RMF founder and CEO Dr. Martina C. Fuchs to South Sudan to recruit nutrition staffs and set up the nutrition programs in addition to Juba Teaching Hospital and Juba College of Nursing and Midwifery projects.

Photo: RMF nutrition team conducting health/nutrition education before screening of children for malnutrition

Results and/or accomplishments achieved during this reporting period:

1. Signed Memorandum of Understanding (MOU) with Jonglei State Ministry of Health and Greater Pibor Administrative Area giving RMF the mandate to operate in Ayod, Fangak, Nyirol and Boma.
2. Interviewed and recruited technical nutrition staffs both for the Juba coordination office and for the Targeted Feeding Program sites in Jonglei and Greater Pibor Administrative Area.
3. The recruited nutrition nurses (10) were trained on CMAM and IYCF protocols and guidelines so as to provide standardized and quality nutrition services.
4. Expanded RMF’s Juba office through installation of prefabricated office space which is well furnished accommodating the Juba based nutrition staff and also acting as a space for our visiting field staffs.
5. Installed a storage facility in Juba Teaching Hospital for keeping our nutrition supplies and other OTP/SC equipments temporarily before transporting them to the field.
6. Upgraded the bandwidth of WIFI internet services for Juba Teaching Hospital Resource Centre to enable high speed internet access for the growing RMF team.
7. Needs assessment conducted in Gorwai, Kuach-deng, Kisiongora and Maruwo, and well documented assessment reports guided the intervention in those areas.
8. Procured and delivered communication devices (Thuraya Phones) to all OTP sites and one for Juba office to enable effective communication.
9. Monthly payment of Thuraya subscription fares to enable effective communication without interruption.
10. Procured all equipments and supplies required for OTP establishment and delivered them to OTP sites through chartered commercial and UNHAS aircrafts.
11. Established four OTPs, two each in Boma and Ayod Counties providing adequate nutrition services to the indigenous community as well as the Internally Displaced Persons.
12. A total of 125 SAM (Severe Acute Malnutrition) children are enrolled in our Targeted Feeding Program and are benefiting from this project.
13. Coordinated RMF nutrition activities with UNICEF, UN agencies, nutrition cluster and other nutrition partners both at the National and State levels.

Number served/number of direct project beneficiaries:

1. Direct project beneficiaries are approximately 161,116 people living in the Payams assigned to RMF projected based on the 2008 South Sudan Population and Housing Census.
2. The project is aimed at treatment and provision of multi-micronutrients to about 7,214 SAM (Severe Acute malnutrition) Children and provision of multi-micronutrient supplements to 19,143 Pregnant and Lactating Women (PLW).

Number of indirect project beneficiaries (geographic coverage):

1. Indirectly targeted is the whole population of the four Counties assigned to RMF, estimated to be 450,129 based on the 2008 South Sudan Population and Housing Census.
2. The population of 1,622,242 in Jonglei State and Greater Pibor also benefits from the project indirectly as there is frequent movement of the people across the Counties.
3. The nutrition service centers also receive beneficiaries from the neighboring Counties and Internally Displaced Persons from various areas of Jonglei State and other States in South Sudan.

Project Photos

(Left) Doyen International Company contracted by RMF laying foundation for the lavatory. (Right) Office foundation well dried and the contractor ready to install the pre-fabricated office

Contractor offloading the prefab panels

 
Contractor installing prefabricated RMF office

Installation of prefabricated RMF office in progress

Well furnished RMF office space for nutrition team

Received nutrition supplies from UNICEF

(Left) Basic materials procured by RMF for establishing nutrition intervention sites (Right) Recruited nutrition nurses attending CMAM & IYCF training in Juba being conducted by RMF technical team

 
Group work during the CMAM and IYCF training

(Left) Taban Lino, a group representative, presenting in plenary after group discussion (Right) Afisha Kojoiki, a group representative, presenting in plenary

Group photo, comprising of the trainees and the trainers, at the end of the training

Solar panel and Thuraya phone together with its accessories procured for each of the OTP/SC sites

Dr. Martina Fuchs and Dr. Taban onboard to Bor to sign MOU with Jonglei State Ministry of Health. (Right) James Alier on his way to Maruwo and Kisiongora Payams from Boma headquarter to conduct rapid needs assessment

(Left) James Alier (R) in Kisiongora Payam in Boma County discussing with Payam health officer (L) during his rapid needs assessment of area
(Right) Community in Kisiongora gathered at the only water point fetching water for domestic use

(Left) James interacting with the community, mainly children, in Kisiongora with more emphasis on their nutrition state
(Right) Compound constructed by Alian Company, a company supporting wildlife conservation in Maruwo Payam

Kennedy, RMF M&E Coordinator, taking the team through M&E tools before leaving for Boma

Grace and Charles taking the M&E tools from the office to join their colleagues on the way to Juba International Airport

 
Truck loaded and Kisiongora team arrived at Boma airstrip using hired commercial aircraft

 
Hired community members carrying the tents to a place allocated to RMF by County Authority

 
(Left) Installation of the tent in progress (Right) RMF team walking from their base to the next village to conduct screening of children under 5 for malnutrition and provision of nutrition/health education to the community

 
(Left) RMF team walking from their base to the next village to conduct screening of children under 5 for malnutrition and provision of nutrition/health education to the community (Right) RMF nutrition team conducting nutrition and health education to the gathered population following mobilization

 
RMF nutrition team conducting nutrition and health education to the gathered population following mobilization

Screening of children using MUAC tape as a screening method recommended by WHO/UNICEF/MOH for enrolment of children on TFP (Right) RMF nutrition team measuring the weight of a malnourished child

Taban Lino carrying out appetite test

(Left) James carrying a malnourished child (Right) SAM (Severe Acute Malnutrition) child without complications requiring medication just enrolled on nutrition program

 
(Left) A SAM child without complications requiring medication just enrolled in nutrition program (Right) Severely acutely malnourished children with their parents awaiting to receive nutrition supplements

 
(Left) RMF Kisiongora team doing proper recording of all the beneficiaries enrolled on TFP (Right) Loading nutrition and other supplies for Maruwo team to be taken to Juba International Airport

 
(Left) RMF team led by M&E Coordinator Kennedy arrived safely in Maruwo Payam in Boma County (Right) The military in Maruwo are helping to transport RMF supplies from the airstrip to the designated place

 
(Right) Grace (L), RMF Nutrition Nurse, with local Area Administrator in Maruwo (Left) The Area Administrator showing Grace the area allocated for RMF to set up the OTP

 
(Left) Community volunteers installing the accommodation tents (Right) Storage tent (L) and accommodation tent (R) well installed

 
(Left) Kennedy, the M&E Coordinator, in-front of installed tent (Right) RMF team trying to set fire for cooking

 
(Left) Local area women delighted to receive RMF team in Maruwo (Right) RMF team joined COSV team conducting screening for malnutrition in Katdolok (Kuach-deng Payam in Ayod County) during rapid needs assessment

 
(Left) Joint RMF-COSV team taking the height of a child during screening of children and PLW for signs of malnutrition in Katdolok (Kuach-deng Payam in Ayod County) (Right) A trained CHW screening a child for malnutrition using MUAC criteria

 
(Left) Okang Wilson, RMF staff, registering the beneficiaries who are enrolled in TFP (Right) COSV team checking the registers before issuing out nutrition supplies to the beneficiaries

 
(Left) Phillips, RMF Logistic Coordinator, cross checking the OTP recording tools (Right) RMF nutrition team (R-Three) on arrival to Katdolok to establish OTP following previous needs assessment

 
(Left) RMF team setting up their accommodation tent inside the common agency compound (Right) Modi, RMF Nutrition Nurse, checking the storage tent after installation

 
(Left) Children gathered near RMF OTP site following mobilization of the community (Right) RMF nutrition team organizing to conduct screening of children for malnutrition

 
(Left) RMF nutrition team conducting health/nutrition education before screening of children for malnutrition (Right) RMF Nutrition Nurse taking MUAC of a child during screening

 
(Left) Nutrition Nurse checking for bilateral pedal oedema (Right) Measuring the weight a child during assessment of nutrition status of children

 
(Left) A SAM child just enrolled on TFP provided with nutritional supplement (Right) RMF nutrition team at Juba International Airport about to leave for Mogok

 
(Left) RMF nutrition team onboard to Mogok led by the Nutrition Coordinator (L) Christopher Lawoko (Right) RMF nutrition team onboard to Mogok using hired helicopter operated by UNHAS

 
RMF team together with community members installing the storage tent in Mogok
  
 
RMF team together with community members installing the storage tent in Mogok

Installation of staff tent in progress

(Left) Well installed two medium size staff tent (Right) Afisha, RMF Nutrition Nurse, taking a mattress to her tent

(Left) Small size tent for our only female nutrition nurse (Right) Joyful children offering fruits of coconut palm  to RMF Nutrition Nurse 

(Left) RMF Nutrition Nurse eating fruit from coconut palm given to them by the community (Right) RMF team meeting with community authority to make them aware of our mission

(Left) RMF team meeting with community authority to make them aware of our mission (Right) RMF team touring the only PHCU in Mogok administration area

(Left) Community gathered at just established RMF OTP site following mobilization (Right) RMF nutrition team conducting health/nutrition education to the community before conducting actual screening of children under 5

(Left) RMF nutrition team conducting health/nutrition education to the community before conducting actual screening of children under 5
(Right) Mothers with their children queuing up to undergo screening for signs of malnutrition

(Left) RMF Nutrition Nurse taking weight of child during screening (Right) RMF nutrition nurse measuring the MUAC of a child during screening

(Left) A severely malnourished child just enrolled in feeding program following assessment (Right) RMF Nutrition Coordinator Christopher standing, working with the team to ensure proper screening and recording

(Left) Mogok RMF nutrition team in RMF T-shirts with the members of local authority (Right) RMF nutrition team with Catholic Priest Anthony who has spent over 25 years in Mogok Payam in Ayod County

(Left) Christopher (L) posed for photo with Catholic Priest Anthony (Right) The only source of safe drinking water about 500m from RMF OTP site

RMF Nutrition Nurse (L) with a community volunteer carrying water from the borehole to RMF compound