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

RMF/UNICEF Malnutrition Treatment and Prevention Project Q2 2015

October 20, 2015

Dr. Taban Martin Vitale

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

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. Recruited an experienced nutrition coordinator, a South Sudanese national who replaced the former one who resigned to join UNICEF.
  2. Procured all the necessary equipments for establishing an OTP in Gorwai Payam and a SC in Thuop Village of Mogok Payam, all in Ayod County.
  3. Procured two additional communication devices (Thuraya phones) for the two new sites established during this reporting quarter (Gorwai and Thuop); this is 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.
  4. Chartered UNHAS operated helicopters which delivered nutrition supplies, OTP and SC equipments, foodstuffs and the trained nutrition staffs to Thuop (Mogok Payam) and Gorwai Payams in Ayod County.
  5. Facilitated and established one additional OTP, making it a total of five and one SC in our areas of intervention all providing adequate CMAM and IYCF services.
  6. Conducted rapid needs assessments in Labrab Payam in the Greater Pibor Administrative Area for the possibility of establishing an OTP there however, the community is pastoralist and keeps moving in search of water, making it not suitable for a fixed TFP center.
  7. Conducted rapid needs assessments in Kandak Village in Mogok Payam of Ayod County to pave the way for setting up another OTP there to serve more beneficiaries.
  8. Continued to procure and deliver essential foodstuffs to all our TFP sites for our nutrition team.
  9. Continued to replenish our nutrition supplies in all our sites of operation through chartering UNHAS operated helicopters and some commercial airline companies.
  10. Conducted on the job training on CMAM and IYCF for all our nutrition staffs in all the sites so as to provide quality services.
  11. Amended our PCA document and submitted to UNICEF for approval dropping Fangak and Nyirol due to logistical challenges so as to allow us concentrate in Ayod and Boma.
  12. Procured and installed solar system in RMF Juba office to ensure smooth running of activities at the coordination office as the national grid is inconsistent.
  13. Continued support of high WIFI internet services to facilitate easy coordination.
  14. Procured and delivered two new laptops for nutrition program, the two are being used by the accountant and the nutrition coordinator.

Results and/or accomplishments achieved during this reporting period:

  1. Interviewed and recruited an experienced nutrition coordinator who now oversees the implementation of the whole nutrition program in accordance with national policy guidelines.
  2. Interviewed and recruited local staffs from our areas of operation to support the trained CMAM nurses taken from Juba.
  3. The locally recruited nutrition staffs were trained on basic CMAM and IYCF protocols and guidelines during establishment of TFP centers and routine M&E visits by the nutrition coordinator, M&E coordinator and nutrition field coordinators so as to provide standardized and quality nutrition services
  4. Continued provision of essential foodstuffs to all our TFP sites since all our areas of intervention are hard to reach and getting basic foodstuffs there is not possible.
  5. Procured all the essential OTP and SC equipments and delivered them to the two new sites through chartered UNHAS operated helicopters.
  6. Established one OTP in Gorwai Payam in Ayod County making the total number of OTPs in Ayod to be 3 while the number in Boma is 2.
  7. Established one Stabilization Center (SC) in Thuop Village in Mogok Payam of Ayod County providing inpatient management for SAM cases with medical complications.
  8. Procured and provided two additional Thuraya phones for the two new sites established during this reporting quarter.
  9. Monthly payment of Thuraya phone subscription fares to enable effective communication without interruptions.
  10. Needs assessment conducted in Labrab (Greater Pibor Administrative Area) and Kandak in Ayod County to pave the way for establishing OTPs there. Labrab is not suitable for a fixed OTP due to population movement while the biggest challenge in Kandak is lack of clean water however RMF will pursue the establishment of an OTP there in the next quarter.
  11. Continued replenishment of nutrition supplies in all our OTP and SC sites through chartered commercial and UNHAS operated aircrafts.
  12. By the end of the second quarter (June), a total of 2,032 children under 5 were screened for malnutrition and 367 SAM cases enrolled in our feeding program.
  13. A total of 255 and 288 children received deworming tablets and Vitamin A supplementation, respectively, in our TFP sites as per national protocol.
  14. 846 mothers received appropriate key messages on IYCF in our areas of intervention.
  15. Coordinated RMF nutrition activities with UNICEF, UN agencies, nutrition cluster and other nutrition partners both at the national and state levels.
  16. RMF Juba coordination office now has a reliable source of power backup by the installed solar system, making day-to-day running of activities easier.
  17. The RMF Juba based staff, visiting nutrition staffs from the various field locations, and JTH staffs are benefiting from the high WIFI internet services installed in the RMF office.

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 aimed at treatment and provision of multi-micronutrients to about 7,214 Severe Acute Malnourished 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

Installation of solar system in RMF Juba office as a backup since JTH electricity is unreliable due to fuel crisis

Technicians checking the solar panels before installation on top of the roof

Technician carrying the solar panel to the top of the roof

Technician carrying the solar panel to the top of the roof

Technicians installing the four procured solar panels on top of the roof, a block housing one of the RMF offices

Technicians carrying the solar batteries to install inside the office

Technicians checking the wiring system in the meter box

Technician connecting the solar batteries inside RMF office

RMF accountant Fred putting RMF stickers on the two laptops procured by RMF for nutrition program

An IT specialist installing the necessary software in the two newly procured laptops

Nutrition supplies received from UNICEF Juba warehouse now to be loaded in our store

Janitors at JTH loading the received nutrition supplies into RMF store

Essential medicines & consumables procured from SONIA for establishing a SC in Mogok Payam, Ayod County

Sales manager (R) of SONIA pharmaceutical company discussing with the RMF logistic person about the payment

Janitors organizing nutrition supplies, essential drugs and other SC equipments to be taken to Mogok

Janitors marking each of the items before taking them to the UNHAS warehouse to be lifted to Mogok by helicopter

Mogok OTP site is flooded following heavy rainfall, our nutrition coordinator arrived here a day earlier to set up SC

Flooded area as the place given to RMF by local authority is low laying

Mogok nutrition manager (R) together with community members clearing this areas for relocating our OTP/SC

This high laying area giving to RMF by the local authority is to install the tents and set up the clinic

Installing the main tents

Transferring all the RMF items to this new site

Well installed tents acting as a clinic for management of SAM cases with medical complications

Installation of the tent in process

RMF Nutrition Coordinator conducting basic training for the nutrition staff

RMF Nutrition team for lunch break and will continue with the training after this

Mobilized community waiting for screening

Mobilized community waiting for screening

RMF Nutrition staff registering the children under 5

Visibly malnourished child (R) awaiting screening

RMF CMAM Nurse assessing a child for signs of malnutrition using MUAC (Mid Upper Arm Circumference) method

RMF CMAM Nurse taking the weight of a child during routine screening of children under 5

RMF nutrition team taking the height of a child during assessment

RMF nutrition site manager in Mogok SC/OTP checking the record register during assessment

RMF M&E Coordinator Kennedy (middle) with local authority in Kandak during needs assessment

Site chosen by Kandak local authority for RMF to set up the OTP

Non functional clinic set up by IOM during rapid respond mission in February 2015

The only school in Kandak run by a local NGO, CMD (Christian Mission Development)

The only borehole in Kandak which is non functional due to lack of repair

The community and the animals share this kind of water as the only water access which also dries up during dry season

A mobile RMF tent temporary installed here to accommodate our M&E Coordinator during the assessment

Kennedy and our Nutrition volunteers taking a rest as they walk from Kandak to Mogok for him to take a flight to Juba

Jubilant Kennedy (R) with Nutrition volunteers after arriving in Mogok SC/OTP

Kennedy checking the quality of the recording tools filled by our Nutrition team in Mogok

James, RMF Field Coordinator (M) discussing with Labrab community members during assessment

James, RMF Field Coordinator (M), discussing with the Labrab community members during assessment

James with pupils in the only primary school in the area

Teaching in progress in the only primary school

James visited the site of source of water which both the community and the animals depend on

James together with the community fetching water