**Ministry of Health, Government of Southern Sudan**

![](media/image1.wmf){width="2.625in" height="2.375in"}

**Basic Package of Health Services**

**For Southern Sudan**

Second draft for further review -- March 2006

**ACKNOWLEDGEMENT**

The Basic Package of Health Services has been prepared with the
technical assistance of the Ministry of Health, Government of Southern
Sudan, Senior Staff and WHO through a project funded by the Italian
Cooperation.

Therefore, on behalf of the Ministry of Health, Government of Southern
Sudan, I would like to take this opportunity to thank all individuals,
International and National Organizations institutions, and agencies that
contributed to the development of this draft document.

In particular, the Ministry would like to acknowledge and thank the
Italian Cooperation for funding the development of this document and WHO
for technical assistance and guidance.

Special thanks to all the senior staff, especially Dr. Samson Baba, Dr.
Nathan Atem and Dr. John Rumunu and Dr. Olivia Lomoro at the Ministry of
Health, Government of Southern Sudan for their technical input and
cooperation in creation of this document. Profound thanks also goes to
the Health and Nutrition Consultative Group whose constructive feed back
have contributed and shaped the content of these documents based on
realities on ground.

Please, note that this is a draft document under further review and
development.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Dr. Majok Yak Majok**

**The Under Secretary,**

**Ministry of Health, Government of Southern Sudan**

**TABLE OF CONTENTS**

Acknowledgement.........................................................................................
2

[Acronyms 4](#acronyms)

[Introduction 5](#introduction)

[1. Service Profile 8](#service-profile)

[1.1. Community-based health activities (detailed service profile: annex
I.1.) 9](#detailed-service-profile-annex-i.1.)

[1.2. Primary Health Care Unit (detailed service profile: annex I.2.)
10](#detailed-service-profile-annex-i.2.)

[1.3. Primary Health Care Centre (detailed service profile: annex I.3.)
11](#primary-health-care-centre)

[1.4. County Hospital (detailed service profile: annex I.4.)
12](#county-hospital-detailed-service-profile-annex-i.4.)

[1.5. County Health Department (detailed service profile: annex I.5.)
13](#county-health-department)

[2. Overview of facilities, interventions and services provided
14](#overview-of-facilities-interventions-and-services-provided)

[2.1. General overview of key facilities, interventions and services
14](#general-overview-of-key-facilities-interventions-and-services)

[2.2. Primary Health Care Unit Summary
15](#primary-health-care-unit-summary)

[2.3. Primary Health Care Centre Summary
16](#primary-health-care-centre-summary)

[2.4. County Hospital Summary 17](#county-hospital-summary)

[2.5. Equipment 19](#equipment)

[2.6. Human Resources 19](#__RefHeading___Toc130206998)

[2.7. Reproductive Health 21](#reproductive-health)

[2.8. Child Health and Immunisation 22](#child-health-and-immunisation)

[2.9. Communicable Diseases 23](#communicable-diseases)

[2.10. Nutrition 24](#nutrition)

[2.11. Water and sanitation. 25](#water-and-sanitation.)

DOCUMENT WITH ANNEXES:

[Annex]{.smallcaps} I. [Detailed Service Profiles]{.smallcaps}

[Annex]{.smallcaps} II. [Resources]{.smallcaps}

[Annex III. Sectors]{.smallcaps}

[Annex]{.smallcaps} IV. [Contacts]{.smallcaps}

[Annex V. References]{.smallcaps}

# ACRONYMS

ABC Abstinence, Be faithful, Condom use

ARI Acute Respiratory Infection

ARV Anti Retroviral therapy (against HIV)

CHD County Health Department

CHW Community Health Worker

CMOH County Medical Officer of Health

CPT Cotrimoxazole Prophylactic Treatment

CTC Community-based Therapeutic Care

DOTS Directly Observed Treatment -- short course

EmOC Emergency Obstetric Care

EWARN Early Warning Alert and Response Network

FGM Female Genital Mutilation

GAM Global Acute Malnutrition

GAVI Global Alliance for Vaccines and Immunisation

GFATM Global Fund against AIDS, Tuberculosis and Malaria

GOSS Government of Southern Sudan

HHP Home Health Promoter

HNCG Health and Nutrition Consultative Group

IMCI Integrated Management of Childhood Illnesses

ITN Insecticide Treated Net

IEC Information, Education and Communication

IECHC Integrated Essential Child Health Care

JAM Joint Assessment Mission

MCH Mother and Child Health

MDG Millennium Development Goal

MICS Multiple Indicator Cluster Survey

MoH Ministry of Health (GOSS)

MUAC Mid Upper Arm Circumference

NID National Immunisation Day

OPD Outpatient Department

PMTCT Prevention of Mother to Child Transmission (of HIV)

RUTF Ready to Use Therapeutic Food

SoH Secretariat of Health (predecessor of MoH)

SSRC Sudan Relief and Rehabilitation Commission

STI Sexually Transmitted Infection

TBA Traditional Birth Attendant

VCT Voluntary Counselling and Testing

# INTRODUCTION

Southern Sudan has suffered until very recently from civil war since
independence in 1956, with a brief respite in the latter 1970s. Southern
Sudan covers an area of approx. 640'000 kilometres divided into ten
states[^1] with over 90 counties. The population is estimated at 7.8 --
10 million and expected to increase to up to 12 m until 2010, owing to
returnees and natural growth. Southern Sudan is one of the poorest
regions in the world, although prospects of oil revenue promise future
economic improvement. Most socio-economic and health indicators are
below the level of the rest of Sudan. Indicators of primary school
enrolment and completion as well as adult literacy are among the worst
world-wide. Infant mortality rate is estimated at 150/1000 live births
and under-five mortality rate at 250/1000 live births. Routine
immunisation coverage is well below 10%[^2] and total fertility rate is
estimated to be higher[^3] than average in Sub-Saharan Africa.
Gender-related health risks are common; the proportion of births
attended by skilled health staff is also among the lowest in the world.
A wide range of 'tropical' diseases that are controlled elsewhere are
endemic in Southern Sudan; many of these are also so-called 'neglected
diseases'. Despite the end of widespread famine, malnutrition among
children remains endemic. With few exceptions, population density is
low, which remains an obstacle to both service provision and access to
health care.

NGOs have played an important role in the delivery of health services in
Southern Sudan; UNICEF, USAID, WFP, and WHO has played a major role
among the UN agencies. Interventions were often disjointed and
inefficient though, and the focus on first-level health services and
disease specific programmes -- typical for humanitarian action - has
overshadowed attention to first-level referral hospitals and capacity
building for mid-level and higher professionals. Overall access to
health care remains minimal (user rate has been estimated as low as 0.2
contacts per person per year). Shortage of skilled human resources has
been -- and is -- one of the major limiting factors to the provision of
care, and the care provided is often poor. Traditional medicine is
practiced either out of conviction or because no other means of care are
available. The private for-profit sector is minimal and not expected to
play a big role in the near future apart from a small number of urban
centres.

The World Bank leads a Multi-Donor Trust Fund that will channel
resources to the health sector for the coming years. The expected flow
of external funds for the health sector -- expected to be limited in
time -- can be put to better use if contributing to build one health
system instead of continuing 'projectism'. In this perspective the
MoH-GoSS advocates an integration of the existing vertical programs in
the resource pool and in the management structures of the mainstream
health system. The definition of the Basic Package of Health Services
(BPHS) is guided by the values recently defined in the MoH Policy Paper,
namely: right to health, equity, pro-poor, community ownership and good
governance. The main criteria for the choice of services were the ones
that would have the greatest impact on the health of the population,
that would be equally accessible to the largest possible part of the
population and be affordable on the short run and sustainable on the
long run.

The BPHS for Southern Sudan includes curative, preventative, managerial
and health promotion activities, whether provided by the Ministry of
Health, Government of Southern Sudan (MoH-GoSS), State Ministries of
Health (SMoH) or contracted out to implementing partners (Faith-Based
Organisations or NGOs). In the latter case, the capacity of the MoH-GoSS
and the State Ministries of Health for tendering and supervision has to
be strengthened in order to allow it to fulfil its responsibilities.
Whoever implements the BPHS will have the obligation -- and be given the
funds - to implement the full package for a defined geographical area.
The importance of mechanisms of monitoring and accountability at all
levels cannot be stressed enough.

The BPHS attempts to be valid for the immediate future and until 2011.
It has therefore to be realistic on the one hand -- especially with
regard to available skilled human resources -- and, on the other hand,
define a level to aspire to. Getting from here to there will happen by
staging it in two ways, and both ways will be applied at the same time:
first, by increasing the geographical coverage of the -- ideally full --
BPHS, secondly (as synchronisation of production of the various
resources needed will be difficult) by introducing its elements
gradually; facility-based deliveries, for instance, will be introduced
only once a Community Midwife is available and ARVs only once
uninterrupted supply can be guaranteed (and mostly in state hospitals).
A strong warning is indicated for both kinds of staging: the
introduction and perpetuation of substandard health services will lead
to low staff morale and to under-use by the population. Once such a
vicious circle has set in, it will be very difficult to break. In case
of contracting-out, the staging has to be specified in the contract
between the three parties (implementing partner, MoH-GoSS and donor).
Because of the large geographic diversity in terms of existing health
structures and human resource availability the implementation
arrangements of the BPHS might differ initially by region.  The specific
details, e.g. the timing of the stepped approach to reach the full BPHS
package, will therefore be covered through individual agreements between
the MoH-GoSS and the implementing organization.  These agreements will
take into account the actual situation per region and the realistic
targets to be achieved within the agreement period. The availability of
qualified man-power to deliver the BPHS is the single most important
factor that will limit the expansion of its coverage and the
implementation of all its components.

The first version of the BPHS is expected to have a life-span of 3
years, for the strategy period 2006-2008; work on a revised version for
the second strategy period 2009-2011 should start in the beginning of
2008. This document is the result of a one-month bilateral consultation
process with key stakeholders and literature research. After first
analysis by the MoH-GoSS, it was submitted to the Health and Nutrition
Consultative Group. The first draft of the document was discussed in a
consultative workshop in Juba in February 2006, whose outcome was
discussed in the Health and Nutrition Consultative Group (HNCG). The
second draft was developed incorporating the recommendations received by
sector stakeholders. Considerations resulting from the subsequent
costing exercise will then have to be taken into account for the final
version.

The BPHS includes five levels of facilities/services:

1.  Community-based health activities

2.  Primary Health Care Unit (PHCU)

3.  Primary Health Care Centre (PHCC)

4.  County Hospital (CH)

5.  County Health Department (CH)

The BPHS does not intend to address higher levels of the health system,
such as State Hospitals, or National reference laboratories etc.

The service profiles at the five levels are described (which should be
binding for any service provider) as well as - only in indicative
fashion (and therefore to be intended largely as a recommendation) - the
resources needed: infrastructure, equipment, essential drug supply and
human resources. The BPHS document also covers a number of specific
sectors more in depth, such as reproductive health, child health and
immunisation, communicable diseases, water and sanitation, and
nutrition. The main document presents the BPHS service profile in very
succinct form (section 1), presents key elements of sector activities
(section 2) and gives a summary overview of key elements in table form
(section 3). The document with annexes presents details with regard to
service profile (annex I) resources (annex II), sectors (III), contacts
made (IV) and references used (V).

The first draft BPHS was elaborated by WHO during the month of November
2005, funded by the Italian co-operation through the First Steps project
of the UN work plan 2005. The author of this draft expresses his warmest
thanks to the MoH and to all others who have contributed: WHO
colleagues, staff members of UN agencies and NGOs, and individual
consultants. The second draft was prepared after the consultative
workshop held in Feb 2006. The inputs received by the participants to
the workshop proved very valuable and constructive to the finalization
of the document.

# 1. SERVICE PROFILE

Southern Sudan cannot go back to simply running the health services
functioning before the war. The necessity to define nearly from scratch
profiles and coverage of health services is an opportunity for effective
planning and equitable distribution. Intermediate targets for 2011 with
regard to the coverage of the population with health services have been
set and adopted in the Health Sector Recovery Strategy and by the JAM
reports. The BPHS is based on these figures, as illustrated in table 1.

[Table 1]{.underline}: Health facilities per population and total number
of health facilities according to the Health Sector Recovery Strategy.

  ---------------------- ----------------------- ------------------------
  **Type of health       **Facilities per        **Total no. of
  service**              population** [^4]       facilities**[^5]

  Primary Health Care    1 / 15'000              800
  Unit                                           

  Primary Health Care    1 / 50'000              240
  Centre                                         

  County Hospital        1 / 300'000             40
  ---------------------- ----------------------- ------------------------

Although these figures may still change according to the process of
formulation of a health care network development plan and regional
variations may apply according to the baseline situation, they do
provide a useful framework of reference for a discussion on the BPHS. In
any case the service profile levels required and the inputs recommended
by the BPHS should not vary if these population-to-health-facility
ratios were to change.

The availability of financial resources for the MoH will be a key
determinant for the staging of over-all coverage. Regional variations
will have to be allowed for, according to criteria of population
density, geographical accessibility and resource availability.

Shortage of skilled human resources is -- and will remain - one of the
main limiting factors for the provision of health services in Southern
Sudan, which requires an enormous investment in training. On the short
run, already, a common salary scale including hardship allowances needs
to be established as integral part of the BPHS.

The BPHS should not be an obstacle to innovation. Mere efficacy of a
strategy, however, should not allow adopting it for the whole country if
it was implemented in near-ideal conditions -- especially on a small
scale by an international NGO with considerable resources. Models of
health care provision that have not been sufficiently tested in Southern
Sudan or comparable circumstances (such as mobile Primary Health Care
Units) should therefore be piloted under conditions and with means with
which the Ministries of Health will have to operate, before implementing
them in a large scale.

## 1.1 COMMUNITY-BASED HEALTH ACTIVITIES 

## (DETAILED SERVICE PROFILE: ANNEX I.1.)

Although the Government of Southern Sudan, through the Ministry of
Health and State Ministries will be paying staff salaries, it is
important, however, that certain curative and especially preventative
health activities are carried into and supported by the community. The
BPHS foresees co-operation with Health Committees and a network of Home
Health Promoters, which are to be supported by the State Ministries of
Health, in collaboration with the Ministry of Health, Government of
Southern Sudan. The following tasks descriptions are ambitious and are
not liable to be attained everywhere. However, if an implementing
partner wishes to invest in a community that strives at empowerment,
guidelines are to be given in the BPHS.

***1.1.1. Health Committees***

The Health Committee consists of elected community members. Care must be
taken that these are representative of the whole community with regard
to gender, religion, ethnicity, occupation and geographical origin.
Among its key functions are:

-   Acting as a custodian of the liaison between the SMoH, the service
    provider and the community

-   Facilitating and encouraging community-based health development
    initiatives

-   Identification and proposal to the CHD of candidates to be trained
    as CHWs

-   Support and supervision of the local health services (PHCU/Cs)
    through:

    -   Mobilisation of the community in supporting PHCU/C
        infrastructure and maintenance

    -   Management of the cost-sharing / revolving drug fund schemes (if
        applicable)

    -   Overseeing drug management

***1.1.2. Home Health Promoters***

Home Health Promoters (HHPs) are elected by the Health Committee and
trained by the CHD and PHCU/Cs. Literacy is an advantage, but not
mandatory. HHPs are not intended to be full-time professionals of the
health system and as such receive no salary, but are motivated through
other material and non-material incentives. HHPs should be residents in
the community they serve and committed to serve all residents without
distinction. Their key functions include:

-   Health promotion (IEC, social marketing of condoms and Water-Guard)

-   Active case finding and referral

-   Mortality surveillance

In geographically very isolated areas, Integrated Essential Child Health
Care (IECHC) may be implemented, provided that the implementing partner
has sufficient capacity for training and supervision. In many cases,
however, this strategy will be self-defeating; isolated areas are less
likely to offer suitable candidates for training and are difficult to
reach for supervision. Conditions allowing, HHPs would then also carry
out the following IECHC activities for children under five:

-   Treatment and guidance for children with diarrhoea, ARI and fever,
    with ORS/zinc, amoxicillin and ACT, respectively

-   Referral of sick children to PHCU/C

This list of tasks attributed to this cadre is intended to be
comprehensive, and not necessarily it is to be implemented in full by
each HHP: for instance some might be involved in social marketing of
preventive commodities only, others in community based IECHC activities
only, others in peer education on HIV and STDs only etc. The HHPs will
be supported, supervised and coordinated by full-time salaried personnel
of the PHCUs.

***1.1.3 Traditional birth attendants (TBAs)\_***

Although investment directed at reducing maternal mortality will be made
in training midwives and not in training Traditional Birth Attendants
(TBAs), co-operation with already trained TBAs can be continued until
the uptake of facility-based deliveries, itself conditioned by staffing
PHCU/Cs with Community Midwives. The BPHS does not support the training
of new TBAs. Organizations that wish to continue training TBAs should do
so with their own funding and demonstrating that at the same time they
are investing in the training of midwives. TBAs can continue being
supported as other HHPs in roles other than the deliveries, such as IEC
activities, iron-folic supplementation, IPT etc.

##  1.2 PRIMARY HEALTH CARE UNIT

## (DETAILED SERVICE PROFILE: ANNEX I.2.)

Primary Health Care Units (PHCUs) are first-line health facilities
functioning mostly in traditional buildings. One PHCU covers a
population of roughly 15'000. Three health staff - two Community Health
Workers and a Mother and Child Health Worker (to be replaced by a
Community Midwife) - provide basic preventive and curative services. One
of the CHWs is primarily in charge of the curative activities and is
therefore based in the PHCU, while the second is responsible for
overseeing and coordinating the community based activities implemented
in collaboration with the network of HHPs. In a long term perspective
the CHW in charge of the curative aspects of the PHCUs should be phased
out and replaced by a clinical officer (CO), however this option is not
realistic for the first version of the BPHS and will be considered again
when revising the BPHS for the following triennium (2009-2011). The
choice of drugs does not include injectables or IV fluids.

The implementation of mobile PHCUs - supposed to provide the same
services with the same resources to nomadic and isolated populations --
is to be piloted. The cost implications of such mobile units, however,
do not warrant the adoption of this strategy on a vast scale.

Key activities of a PHCU are:

-   Preventive care and health promotion (EPI and IEC, see annexes
    III.2. and III.5.)

-   Antenatal care, normal deliveries and family planning (see annex
    III.1.), once trained staff is available

-   Curative care for common and uncomplicated diseases

-   Case-finding and treatment of chronic diseases diagnosed at higher
    level

-   Referral to PHCC or CH for complementary exams or treatment, if
    necessary

-   First aid for trauma, stabilisation and referral

-   Home treatment and outpatient care for moderate acute malnutrition,
    follow-up patients with severe acute malnutrition (see annex III.4.)

-   Training activities (of HHPs)

-   Administrative and support activities (HMIS, maintaining registers
    and, if applicable, book-keeping)

## 1.3 Primary Health Care Centre

##  (Detailed service profile: annex I.3.)

One Primary Health Care Centre (PHCC) covers a population of roughly
50'000. It offers a wider range of services than a PHCU, notably
laboratory diagnostics, an observation ward (which may include treatment
of simple cases) and 24-hour basic Emergency Obstetric Care. The PHCC is
staffed with a number of qualified health professionals, including
Clinical Officers (COs) and Nurse Midwives. It also disposes of a wider
range of drugs than PHCUs and can altogether handle more complicated
cases.

Key activities of a PHCC are:

-   Preventive care and health promotion (including fixed EPI and IEC,
    see annexes III.2. and III.5)

-   Delivery Care (24-hour basic Emergency Obstetric Care, see annex
    III.1.):

    -   Antenatal Care

    -   Normal and assisted deliveries (vacuum extraction)

    -   Non-surgical management of obstetric complications (basic EmOC,
        e.g. manual placenta removal, post-abortion manual vacuum
        aspiration)

    -   Family Planning

-   Curative care (including IM injections and IV lines for IV fluids
    and antibiotics)

-   Home treatment and outpatient care for moderate and severe acute
    malnutrition; stabilisation care for severe acute malnutrition (see
    annex III.4.)

-   First aid for emergency conditions and referral

-   Small surgery (incl. first aid for trauma, stabilisation and
    referral)

-   Dental care (on fixed days by dental technician from County
    Hospital, once available)

-   TB diagnosis and treatment (DOTS)

-   Laboratory examinations (see annexes I.3. and II.2.1.)

-   Observation, with 10-20 beds

-   Training (for PHCU staff)

-   Health Management Information System

-   Administrative and support activities (e.g. register keeping, drug
    management and maintenance and, if applicable, book-keeping)

## 1.4 County Hospital (detailed service profile: annex I.4.)

The County Hospital (CH) is the first-line referral hospital, with
80-100 beds. According to the coverage planned (roughly one CH per
300'000 population), there will actually be one CH per 2-3 countries, in
the near future[^6].

In the CH, patients are diagnosed, treated, referred back to the PHCU/Cs
and also referred up to state and tertiary hospitals once these are up
and running. For the time being, however, it is important to keep in
mind that the large majority of patients will have to be treated at the
CH and not in a higher level hospital.

The outpatient department (OPD) of the CH functions exactly like a PHCC
to serve the population in the catchment area, and is staffed and
equipped like one, with the exception of EmOC, stabilisation care for
malnutrition and the laboratory, for which it relies on the hospital
services. The CH provides basic curative care in the areas of
gynaecology/obstetrics, surgery, internal medicine and paediatrics.
Focus will be on the first of these: 24-hour comprehensive EmOC. Beyond
curative care, like the other health services, the CH participates in
training, epidemiological surveillance and health promotion activities.
Special attention will also be given to managerial and administrative
structures - including a Hospital Board -- and processes

The key activities of the County Hospital are:

-   Curative services

    -   Gynaecology and 24-hour comprehensive EmOC (see annex III.1.)

    -   Surgery (emergency surgery and basic elective surgery)

    -   Internal medicine (incl. TB and other communicable diseases, see
        annex III.3.)

    -   Paediatrics (including stabilisation care for malnutrition)

    -   Emergency services open 24 hours

    -   Safe blood transfusion

    -   Physiotherapy (once available)

-   Outpatient service (same as PHCC, incl. EPI and, if available,
    dental care)

-   Diagnostic services

    -   Laboratory (see annexes I.4. and II.2.1. for details)

    -   Ultrasonography (if available)

    -   X-ray (exceptionally)

-   Management and administration

    -   Supervision of clinical services and resource use

    -   Human Resources management

    -   Health Management Information System

    -   Financial management

    -   Procurement and storage

    -   Maintenance and repair

-   Support services

    -   Sterilisation

    -   Kitchen

    -   Laundry

    -   Waste management

    -   Communication and transportation

## 1.5 County Health Department

##  (Detailed service profile: annex I.5.)

The County Medical Officer of Health (CMOH) as the head of the County
Health Department (CHD) guarantees the implementation of the health
policy, co-ordinates with other authorities and actors and supervises
specific areas, such as:

-   Health promotion

-   Curative services

-   HMIS (routine and early warning system)

-   EPI

-   Pharmaceuticals and medical supplies

-   HR management

-   Administration and Finance

In view of the shortcomings of skilled human resources, many of these
functions may be carried out initially by an implementing partner to
whom the BPHS is contracted out or by a separate partner charged with
the responsibility of building the capacity of the CHDs, in case the MoH
decides that the possibility of conflict of interest warrants a
separation of the roles of service delivery and coordination and
oversight of the same. Whichever option is chosen, it is important,
however, that these functions are located at the CHD and not in the
NGO/FBO partner's office and that investment in infrastructure and
capacity building takes place over the years.

Owing to efficiency considerations, it is proposed that a CHD manages
the health services of 2-3 counties, following the division by placement
of County Hospitals. With regard to decision-making, a consensus between
a potential implementing partner and the CHD has to be sought; key
decisions (e.g. location of health facilities and staff appointments)
have to be approved by the SMoH and MoH-GoSS.

The tables in the next chapter provide a synopsis over the service
profile per level and selected specialised sectors.

# 2. OVERVIEW OF FACILITIES, INTERVENTIONS AND SERVICES PROVIDED

The following tables are not exhaustive, but provide an overview of the
BPHS at one glance by listing key elements at each level and for the
main sectors.

## 2.1 General overview of key facilities, interventions and services

  ------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions,         **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  services provided**                                                           

  Preventive care and health promotion                                          

  Interventions for endemic,                                                    
  'forgotten' diseases                                                          

  Health Management Information System                                          

  Training                                                                      

  **Maternal Health**                                                           

  Antenatal Care and normal deliveries                                          

  Basic EmOC services 24 hs                                                     

  Comprehensive EmOC services 24 hs                                             

  **EPI**                                                                       

  Outreach EPI                                                                  

  Outreach EPI in static facilities                                             

  Fixed EPI                                                                     

  **General Curative Care**                                                     

  Integrated Essential Child Health                                             
  Care                                                                          

  Curative outpatient care                                                      

  Supervision of curative care                                                  

  First aid and referral                                                        

  Small surgery                                                                 

  Observation                                                                   

  Stabilisation care for malnourished                                           
  children                                                                      

  Inpatient care (incl. surgery)                                                

  Safe blood transfusion                                                        

  Dental care                                               (visit)             

  Physiotherapy                                                                 

  Basic specialised care (ENT, eye,                                             
  mental)                                                                       

  **HIV/AIDS**                                                                  

  VCT and PMTCT                                                                 

  **Diagnostics**                                                               

  Laboratory examinations                                                       

  Blood transfusion                                                             

  Ultrasonography                                                               

  x-ray examination (exceptionally)                                             

  Kitchen, laundry                                                              
  ------------------------------------ --------- ---------- ---------- -------- ---------

## 2.2 Primary Health Care Unit Summary

+----------+--------------+------------------+-----------+-----------+
| C        |              |                  |           |           |
| atchment |              |                  |           |           |
| area:    |              |                  |           |           |
| 15'000   |              |                  |           |           |
| po       |              |                  |           |           |
| pulation |              |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
| *        |              | **Human          | **Fac     | **Eq      |
| *Service |              | Resources**      | ilities** | uipment** |
| p        |              |                  |           |           |
| rofile** |              |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
| Repr     | IEC on       | [Techni          | Con       | Ex        |
| oductive | sexual       | cal]{.underline} | sultation | amination |
| health   | health and   | \[3\]            |           | tables    |
|          | HIV          |                  | Rooms (2) |           |
|          |              | Community Health |           | Delivery  |
|          |              | Worker \[2\] (1  | Delivery  | table     |
|          |              | for              | room      |           |
|          |              | facility-based   |           | Fetoscope |
|          |              | curative         | D         |           |
|          |              | activities, 1    | ispensing | St        |
|          |              | for community    | / Store   | ethoscope |
|          |              | based promotive  |           |           |
|          |              | activities)      | Waiting   | Sphygmo-  |
|          |              |                  | area      |           |
|          |              | Maternal and     |           | manometer |
|          |              | Child Health     | Latrine   |           |
|          |              | Worker \[1\]     |           | Th        |
|          |              | replaced by      | Water     | ermometer |
|          |              |                  | store     |           |
|          |              | Community        |           | Dressing  |
|          |              | Midwife          |           | set       |
|          |              |                  |           |           |
|          |              | [Supp            |           | Baby      |
|          |              | ort]{.underline} |           | scale     |
|          |              | \[3\]            |           |           |
|          |              |                  |           | Adult     |
|          |              | Janitor          |           | scale     |
|          |              | (guard/cleaner)  |           |           |
|          |              |                  |           | Bicycle   |
|          |              | \                |           |           |
|          |              | [1-exceptionally |           |           |
|          |              | 2\]              |           |           |
|          |              |                  |           |           |
|          |              | Dispenser \[1\]  |           |           |
|          |              |                  |           |           |
|          |              | (Although this   |           |           |
|          |              | is classified as |           |           |
|          |              | a non-technical  |           |           |
|          |              | staff, this      |           |           |
|          |              | cadre should     |           |           |
|          |              | undergo training |           |           |
|          |              | according to the |           |           |
|          |              | 2 weeks module   |           |           |
|          |              | in the CHW       |           |           |
|          |              | curriculum       |           |           |
|          |              | relative to drug |           |           |
|          |              | management)      |           |           |
|          |              |                  |           |           |
|          |              | Receptionist     |           |           |
|          |              | \[1\]            |           |           |
|          |              |                  |           |           |
|          |              | [Total           |           |           |
|          |              | sta              |           |           |
|          |              | ff]{.underline}: |           |           |
|          |              | \[6\]            |           |           |
|          |              |                  |           |           |
|          |              | It is            |           |           |
|          |              | recommended that |           |           |
|          |              | the person in    |           |           |
|          |              | charge of the    |           |           |
|          |              | PHCU should be   |           |           |
|          |              | the most senior  |           |           |
|          |              | in terms of      |           |           |
|          |              | training         |           |           |
|          |              | undertaken       |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Antenatal    |                  |           |           |
|          | care         |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Normal       |                  |           |           |
|          | deliveries   |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Family       |                  |           |           |
|          | planning:    |                  |           |           |
|          | condoms and  |                  |           |           |
|          | oral         |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
| Child    | Outreach EPI |                  |           |           |
| health   |              |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Outreach EPI |                  |           |           |
|          | in static    |                  |           |           |
|          | facility     |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Treatment of |                  |           |           |
|          | children     |                  |           |           |
|          | with         |                  |           |           |
|          | diarrhoea,   |                  |           |           |
|          | malaria, ARI |                  |           |           |
|          | and anaemia  |                  |           |           |
|          | with oral    |                  |           |           |
|          | drugs, based |                  |           |           |
|          | on IMCI      |                  |           |           |
|          | algorithm    |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
| Communi- | Clinical     |                  |           |           |
| cable    | management   |                  |           |           |
| diseases | according to |                  |           |           |
|          | national     |                  |           |           |
|          | protocols    |                  |           |           |
|          | (incl. DOTS) |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Rapid test   |                  |           |           |
|          | for malaria  |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | CPT and      |                  |           |           |
|          | m            |                  |           |           |
|          | ultivitamins |                  |           |           |
|          | for PLWHA    |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
| N        | Growth       |                  |           |           |
| utrition | monitoring   |                  |           |           |
|          | (to be       |                  |           |           |
|          | defined by   |                  |           |           |
|          | MoH-GoSS Ex  |                  |           |           |
|          | Board)       |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Diagnosis    |                  |           |           |
|          | and home     |                  |           |           |
|          | treatment    |                  |           |           |
|          |              |                  |           |           |
|          | for moderate |                  |           |           |
|          | acute        |                  |           |           |
|          | malnutrition |                  |           |           |
+----------+--------------+------------------+-----------+-----------+
|          | Follow-up    |                  |           |           |
|          | cases of     |                  |           |           |
|          | severe acute |                  |           |           |
|          |              |                  |           |           |
|          | malnutrition |                  |           |           |
|          | (diagnosed   |                  |           |           |
|          | and          |                  |           |           |
|          | stabilized   |                  |           |           |
|          | at PHCC      |                  |           |           |
|          | level)       |                  |           |           |
+----------+--------------+------------------+-----------+-----------+

## 2.3 Primary Health Care Centre Summary

+-----------+------------------+------------+-----------+-------------+
| Catchment |                  |            |           |             |
| area:     |                  |            |           |             |
| 50'000    |                  |            |           |             |
| p         |                  |            |           |             |
| opulation |                  |            |           |             |
+-----------+------------------+------------+-----------+-------------+
| **Service |                  | **Human.   | **Facilit | **          |
| profile** |                  | R          | ies**[^7] | Equipment** |
|           |                  | esources** |           |             |
+-----------+------------------+------------+-----------+-------------+
| Rep       | IEC on sexual    | [Te        | R         | S           |
| roductive | health           | chnical]{. | eception/ | tethoscopes |
| health    |                  | underline} | Regi      |             |
|           |                  | \[11\]     | stration/ | Otoscope    |
| (24-hour  |                  |            | Cashier / |             |
| basic     |                  | Clinical   | Communic. | Sphygmo-    |
| EmOC      |                  |            |           |             |
| services) |                  | Officer    | Staff     | manometer,\ |
|           |                  | \[1\]      | Office/   | Thermometer |
|           |                  |            | on duty   |             |
|           |                  | RN         |           | Baby scale  |
|           |                  | /Certified | Con       |             |
|           |                  | Nurse      | sultation | Adult scale |
|           |                  | \[1\]      | rooms     |             |
|           |                  |            |           | Beds,       |
|           |                  | CHW[^8]    | VCT room  | bedding     |
|           |                  | \[3\]      |           |             |
|           |                  |            | EPI       | Delivery    |
|           |                  | MCHW \[2\] | /Growth   | table       |
|           |                  |            | m         |             |
|           |                  | replaced   | onitoring | Fetoscope   |
|           |                  | by:        |           |             |
|           |                  |            | ANC room  | Delivery    |
|           |                  | Community  |           | equipment   |
|           |                  |            | Maternity | for basic   |
|           |                  | Midwife    |           | EmOC        |
|           |                  |            | Dressing/ |             |
|           |                  | (Nurse-)   | injection | Small       |
|           |                  | Midwife    |           | surgery     |
|           |                  | \[1\]      | Ob        | equipment   |
|           |                  |            | servation |             |
|           |                  | Lab        | ward      | Manual      |
|           |                  | assi       | (10-20    | re          |
|           |                  | stant\[1\] | beds)     | suscitation |
|           |                  |            |           | equipment   |
|           |                  | Public     | Stab      |             |
|           |                  | Health     | ilisation | Autoclave   |
|           |                  | Technician | for       |             |
|           |                  | \[1\]      | mal       | Cold chain  |
|           |                  |            | nutrition | equipment   |
|           |                  | Pharmacist |           |             |
|           |                  | technician | Ster      | Laboratory  |
|           |                  | \[1\]      | ilisation | equipment   |
|           |                  |            |           |             |
|           |                  | Dental     | L         | R           |
|           |                  | tech       | aboratory | efrigerator |
|           |                  | nician[^9] |           |             |
|           |                  | \[1\]      | Pharmacy  | Co          |
|           |                  |            |           | mmunication |
|           |                  | [          | Store     | equipment   |
|           |                  | Support]{. |           |             |
|           |                  | underline} | Lightning | Bicycles    |
|           |                  | \[5\]      |           |             |
|           |                  |            | Borehole  |             |
|           |                  | Record     |           |             |
|           |                  | keeper /   |           |             |
|           |                  |            |           |             |
|           |                  | B          |           |             |
|           |                  | ook-keeper |           |             |
|           |                  | \[1\]      |           |             |
|           |                  |            |           |             |
|           |                  | Re         |           |             |
|           |                  | ceptionist |           |             |
|           |                  | \[1\]      |           |             |
|           |                  |            |           |             |
|           |                  | Cleaner    |           |             |
|           |                  | \[1\]      |           |             |
|           |                  |            |           |             |
|           |                  | Guards     |           |             |
|           |                  | \[2\]      |           |             |
|           |                  |            |           |             |
|           |                  | [Total     |           |             |
|           |                  | staff]{.u  |           |             |
|           |                  | nderline}: |           |             |
|           |                  | \[16\]     |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Antenatal Care   |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | VCT and PMTCT    |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Normal           |            |           |             |
|           | deliveries       |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Non-surgical     |            |           |             |
|           | management of    |            |           |             |
|           | obstetric        |            |           |             |
|           | complications    |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Family planning: |            |           |             |
|           | condoms, oral,   |            |           |             |
|           | depot            |            |           |             |
+-----------+------------------+------------+-----------+-------------+
| Child     | Fixed and        |            |           |             |
| Health    | outreach EPI     |            |           |             |
| and EPI   |                  |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Treatment of     |            |           |             |
|           | children with    |            |           |             |
|           | diarrhoea,       |            |           |             |
|           | malaria, ARI,    |            |           |             |
|           | anaemia with     |            |           |             |
|           | oral and         |            |           |             |
|           | injectable       |            |           |             |
|           | drugs, based on  |            |           |             |
|           | IMCI algorithm   |            |           |             |
+-----------+------------------+------------+-----------+-------------+
| Comm      | Case management  |            |           |             |
| uni-cable | according to     |            |           |             |
| diseases  | national         |            |           |             |
|           | protocols        |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Laboratory       |            |           |             |
|           | diagnosis for    |            |           |             |
|           | malaria, TB, HIV |            |           |             |
|           | and others       |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | VCT and PMTCT    |            |           |             |
+-----------+------------------+------------+-----------+-------------+
| Nutrition | [Growth          |            |           |             |
|           | mo               |            |           |             |
|           | nitoring]{.mark} |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Home treatment   |            |           |             |
|           | of moderate      |            |           |             |
|           | malnutrition     |            |           |             |
+-----------+------------------+------------+-----------+-------------+
|           | Diagnosis/       |            |           |             |
|           | stabilization of |            |           |             |
|           | severe           |            |           |             |
|           | malnutrition     |            |           |             |
+-----------+------------------+------------+-----------+-------------+

##  2.4 County Hospital Summary

+------------+-----------------+---------------+----------+-----------+
| Catchment  |                 |               |          |           |
| area:      |                 |               |          |           |
| 300'000    |                 |               |          |           |
| population |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| **Service  |                 | **Human       | **F      | **Eq      |
| profile**  |                 | Resources**   | acilitie | uipment** |
| (80-100    |                 |               | s**[^10] |           |
| beds)      |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| G          | Normal/         | [Technical    | E        | Beds,     |
| ynaecology | complicated     | ]{.underline} | mergency | bedding   |
| /          | deliveries,     | \[76\]        | ward     |           |
| obstetrics | including       |               |          | Delivery  |
|            | surgical        | Medical       | OPD      | table     |
| (24-hour   | interventions   | Dr[^11] \[2\] |          |           |
| com        | (esp.           |               | O        | Delivery  |
| prehensive | C-sections)     | Clinical      | perating | in        |
|            |                 | Officers      | Theatres | struments |
| EmOC)      |                 | \[4\]         |          |           |
|            |                 |               | M        | Vacuum    |
|            |                 | (Specialised  | aternity | extractor |
|            |                 | COs)          |          |           |
|            |                 |               | Four     | OT table  |
|            |                 | Nurses (RN,   | wards    |           |
|            |                 |               | (one per | OT lamps  |
|            |                 | CN/aux)       | sp       |           |
|            |                 | \[51\]        | ecialty) | Surgical  |
|            |                 |               |          | in        |
|            |                 | (Nurse-       | Stabi    | struments |
|            |                 | )Midwife\[1\] | lisation |           |
|            |                 |               | for      | A         |
|            |                 | MCHW replaced | maln     | utoclaves |
|            |                 | by            | utrition |           |
|            |                 |               |          | An        |
|            |                 | Community     | TB ward  | aesthetic |
|            |                 |               |          | equipment |
|            |                 | Midwife \[5\] | La       |           |
|            |                 |               | boratory | U         |
|            |                 | OPD CHW \[3\] |          | ltrasound |
|            |                 |               | Archives | machine   |
|            |                 | Ph            |          | (if       |
|            |                 | ysiotherapist | Laundry  | possible) |
|            |                 | \[1\]         |          |           |
|            |                 |               | Store    | (exc      |
|            |                 | Anaesth.      |          | eptional: |
|            |                 | Nurse \[2\]   | Workshop | x-ray)    |
|            |                 |               |          |           |
|            |                 | Scrub Nurse   | Kitchen  | L         |
|            |                 | \[2\]         |          | aboratory |
|            |                 |               | Garage   | equipment |
|            |                 | Lab assistant |          |           |
|            |                 | \[1\]         | Inc      | Ref       |
|            |                 |               | inerator | rigerator |
|            |                 | Lab           |          |           |
|            |                 | technician    | Mortuary | Ambulance |
|            |                 | \[1\]         |          |           |
|            |                 |               |          | Commu     |
|            |                 | (X-ray        |          | ni-cation |
|            |                 | technician)   |          | equipment |
|            |                 |               |          |           |
|            |                 | Dent.         |          | Generator |
|            |                 | technician    |          |           |
|            |                 | \[1\]         |          |           |
|            |                 |               |          |           |
|            |                 | Pharmacist    |          |           |
|            |                 | technician    |          |           |
|            |                 | \[2\]         |          |           |
|            |                 |               |          |           |
|            |                 | [Support      |          |           |
|            |                 | ]{.underline} |          |           |
|            |                 | \[31\]        |          |           |
|            |                 |               |          |           |
|            |                 | Administrator |          |           |
|            |                 | \[1\]         |          |           |
|            |                 |               |          |           |
|            |                 | Book-keeper/  |          |           |
|            |                 | \[1\]         |          |           |
|            |                 |               |          |           |
|            |                 | Maternity     |          |           |
|            |                 | Receptionist  |          |           |
|            |                 | \[2\]         |          |           |
|            |                 |               |          |           |
|            |                 | Clerk/ record |          |           |
|            |                 | keeper \[3\]  |          |           |
|            |                 |               |          |           |
|            |                 | Store keeper  |          |           |
|            |                 | \[1\]         |          |           |
|            |                 |               |          |           |
|            |                 | Cleaners      |          |           |
|            |                 | \[12\]        |          |           |
|            |                 |               |          |           |
|            |                 | (Kitchen      |          |           |
|            |                 | staff)        |          |           |
|            |                 |               |          |           |
|            |                 | Laundry staff |          |           |
|            |                 | \[2\]         |          |           |
|            |                 |               |          |           |
|            |                 | Maintenance/  |          |           |
|            |                 | Labourer      |          |           |
|            |                 | \[2\]         |          |           |
|            |                 |               |          |           |
|            |                 | Driver \[1\]  |          |           |
|            |                 |               |          |           |
|            |                 | Guards \[6\]  |          |           |
|            |                 |               |          |           |
|            |                 | [Total        |          |           |
|            |                 | staff]{.und   |          |           |
|            |                 | erline}[^12]: |          |           |
|            |                 | \[107\]       |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Blood           |               |          |           |
|            | transfusions    |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Gynaecological  |               |          |           |
|            | surgery         |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| General    | Emergency       |               |          |           |
| surgery    | surgery         |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Basic elective  |               |          |           |
|            | surgery         |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Anaesthesia     |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Physiotherapy   |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| Internal   | Case management |               |          |           |
| medicine   | of acute and    |               |          |           |
|            | chronic         |               |          |           |
|            | conditions      |               |          |           |
|            | (incl.          |               |          |           |
|            | communicable    |               |          |           |
|            | dis.)           |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| P          | Case management |               |          |           |
| aediatrics | of acute and    |               |          |           |
|            | chronic         |               |          |           |
|            | conditions      |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Management of   |               |          |           |
|            | neonatal        |               |          |           |
|            | complications   |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Stabilisation   |               |          |           |
|            | care for        |               |          |           |
|            | malnutrition    |               |          |           |
|            | with            |               |          |           |
|            |                 |               |          |           |
|            | Complications   |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| 24-hour    |                 |               |          |           |
| Emergency  |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| D          | Laboratory      |               |          |           |
| iagnostics |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Ultrasonography |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | X-ray           |               |          |           |
|            | (exceptional)   |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| OPD[^13]   | Basic ENT, eye  |               |          |           |
|            | and mental      |               |          |           |
|            | health care     |               |          |           |
|            | (where          |               |          |           |
|            | available)      |               |          |           |
|            |                 |               |          |           |
|            | Basic dental    |               |          |           |
|            | care            |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| Management |                 |               |          |           |
| and admin  |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
| Support    | Sterilisation   |               |          |           |
| services   |                 |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Laundry         |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Kitchen         |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Waste           |               |          |           |
|            | management      |               |          |           |
+------------+-----------------+---------------+----------+-----------+
|            | Communic./      |               |          |           |
|            | trsp.           |               |          |           |
+------------+-----------------+---------------+----------+-----------+

##  2.5 Equipment 

  ------------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions, services      **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  provided**                                                                          

  **General**                                                                         

  Computers and internet connectivity                                                 

  Communication equipment                                                             

  [Car]{.mark} [(to be defined by MoH Ex.                                             
  Board)]{.mark}                                                                      

  Ambulance                                                                           

  Motorbike                                                                           

  Bicycle                                                                             

  **Furniture**                                                                       

  Tables, desks                                                                       

  Examination beds                                                                    

  Beds, mattresses, sheets                                                            

  Delivery tables                                                                     

  **Surgical instruments and sterilisation                                            
  equipment**                                                                         

  Dressing sets                                                                       

  Instruments for small surgery                                                       

  OT tables, surgical instrument sets                                                 

  Anaesthesia equipment                                                               

  Autoclave                                                                           

  **Diagnostics**                                                                     

  Sphygmomanometer/stethoscope/thermometer                                            

  Otoscope                                                                            

  Microscope                                                                          

  Ultrasound machine                                                                  

  X-ray machine (exceptionally)                                                       

  **Others**                                                                          

  Refrigerator                                                    (EPI)               (EPI)

  *Generator*                                                                         
  ------------------------------------------ --------- ---------- ---------- -------- ---------

## 

[]{#__RefHeading___Toc130206998 .anchor}

***2.6 Human Resources***

+-----------------------------+----------+---------+-----+-----+-----+
| **Facilities,               | **Com    | *       | **  | **C | *   |
| interventions, services     | munity** | *PHCU** | PHC | H** | *CH |
| provided**                  |          |         | C** |     | D** |
+-----------------------------+----------+---------+-----+-----+-----+
| Volunteers                  |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Home Health Promoters       |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Health Committees members   |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Trained TBAs                |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Technical staff             |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Community Health Worker     |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Mother and Child Health     |          |         |     |     |     |
| Worker /                    |          |         |     |     |     |
|                             |          |         |     |     |     |
| Community Midwife           |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Laboratory Assistant        |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Laboratory technician       |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| x-ray technician            |          |         |     |     |     |
| (exceptionally)             |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Nurse Midwife               |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Certified Nurse / Auxiliary |          |         |     |     |     |
| Nurse                       |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Registered Nurse            |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Public Health Technician    |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Specialised CO              |          |         |     |     |     |
| (e.g.ENT)[^14]              |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Clinical Officer / Medical  |          |         |     |     |     |
| Assistant                   |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Medical doctor              |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Clerical and auxiliary      |          |         |     |     |     |
| staff (several functions    |          |         |     |     |     |
| may be combined in one      |          |         |     |     |     |
| person)                     |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Cleaner / guard             |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Clerk/cashier/record        |          |         |     |     |     |
| keeper/receptionist         |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Kitchen and laundry staff   |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Pharmacist                  |          |         |     |     |     |
| (technician)/storekeeper    |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+
| Administrator               |          |         |     |     |     |
+-----------------------------+----------+---------+-----+-----+-----+

## 2.7 Reproductive Health 

  ------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions,         **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  services provided**                                                           

  **IEC**                                                                       

  Education on sexual health                                                    

  Referral to higher health service                                             

  **Antenatal Care**                                                            

  Identification and referral of                                                
  pregnant women in the community to                                            
  PCHU/C for ANC                                                                

  Clinical examination and search for                                           
  danger signs                                                                  

  Early detection and timely referral  (TBA)                                    
  to either PHCC or County Hospital of                                          
  danger signs in pregnancies and                                               
  obstetric complications                                                       

  Administration of Tetanus Toxoid,                                             
  Albendazole, Ferrous sulphate and                                             
  Folic acid, IPT                                                               

  Syphilis and urine test                                                       

  VCT and, if indicated, PMTCT                                                  

  Management of complications                                                   

  **Delivery Care**                                                             

  Normal deliveries                                                             

  Timely referral of obstetric                                                  
  complications                                                                 

  Non-surgical management of obstetric                                          
  complications and post-abortion care                                          
  (basic EmOC)                                                                  

  Surgical management of obstetric                                              
  complications and post-abortion care                                          
  (comprehensive EmOC)                                                          

  Safe blood transfusion                                                        

  **Family Planning**[^15]                                                      

  IEC                                                                           

  Distribution / social marketing of                                            
  condoms                                                                       

  Oral contraceptives                                                           

  Depot injections                                                              

  IUDs                                                                          

  Surgical contraception                                                        
  ------------------------------------ --------- ---------- ---------- -------- ---------

## 2.8 Child Health and Immunisation 

  ------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions,         **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  services provided**                                                           

  **EPI**                                                                       

  Promoting EPI services among the                                              
  population and mobilising it for                                              
  campaigns                                                                     

  Outreach vaccination                                                          

  Outreach vaccination in static                                                
  facilities                                                                    

  Fixed vaccination                                                             

  Organisation of routine vaccination                                           
  and campaigns                                                                 

  Training and supervising                                                      

  Requesting, storing and distributing                                          
  vaccines and other material                                                   

  Identification and registration of                                            
  target population                                                             

  **IMCI**                                                                      

  Treatment and guidance for children                                           
  with diarrhoea, ARI and fever (only                                           
  where IECHC is implemented)                                                   

  Treatment of children with                                                    
  diarrhoea, malaria, ARI, anaemia and                                          
  malnutrition with oral drugs, based                                           
  on IMCI algorithm                                                             

  Treatment of children with                                                    
  injectable drugs and IV fluids based                                          
  on IMCI algorithm                                                             

  Treatment of severely ill children                                            
  referred from PHCU/Cs                                                         

  Safe blood transfusion                                                        
  ------------------------------------ --------- ---------- ---------- -------- ---------

## 2.9 Communicable Diseases 

  ------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions,         **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  services provided**                                                           

  **General measures**                                                          

  IEC and preventive measures                                                   

  Epidemiological surveillance                                                  

  Organisation of mass treatment                                                

  Supervision of case management                                                

  **Malaria**                                                                   

  Distribution / social marketing of                                            
  ITNs                                                                          

  Clinical case management                                                      

  Case management with rapid test                                               
  diagnosis                                                                     

  Diagnosis with blood smear                                                    

  Case management of                                                            
  severe/complicated cases                                                      

  **Tuberculosis**                                                              

  BCG vaccination                                                               

  Active case detection and referral                                            

  Identification of TB suspects and                                             
  referral to PHCC and CH for                                                   
  laboratory diagnosis (AFS)                                                    

  Laboratory diagnosis (AFS)                                                    

  Clinical management (free DOTS)                                               

  Diagnosis of extra-pulmonary TB                                               

  X-ray investigation (usually in                                               
  state hospital)                                                               

  **HIV/AIDS**                                                                  

  ABC promotion and condom                                                      
  distribution                                                                  

  Passive case detection and referral                                           

  Home based care                                                               

  Cotrimoxazole Prophylactic Treatment                                          
  (CPT) and Multivitamins                                                       

  Treatment of opportunistic                                                    
  infections                                                                    

  VCT and PMTCT                                                                 

  Screening of blood and blood                                                  
  products                                                                      

  **Others, especially 'forgotten                                               
  diseases' and diseases with epidemic                                          
  potential**                                                                   

  According to national protocols                                               
  (early diagnosis and                                                          
  treatment/containment, mass                                                   
  treatment)                                                                    
  ------------------------------------ --------- ---------- ---------- -------- ---------

## 2.10. Nutrition 

  ------------------------------------ --------- ------ ---------- ------ -- ---------- -- -------- -- ---------
  **Facilities, interventions,         **HHP**          **PHCU**             **PHCC**      **CH**      **CHD**
  services provided**                                                                                  

  **Prevention**                                                                                       

  IEC on nutrition (especially                                                                         
  breastfeeding and weaning practices)                                                                 

  [Growth monitoring of children \< 24                                                                 
  months]{.mark}                                                                                       

  Vit A to all children below two as                                                                   
  part of EPI                                                                                          

  Iron Sulphate and Folic Acid to all                                                                  
  pregnant and lactating women                                                                         

  Mass antihelminthic treatment (where                                                                 
  prevalence of hook worms \>20%)                                                                      

  Diagnosis                                                                                            

  Diagnosis moderate acute                                                                             
  malnutrition                                                                                         

  Diagnosis severe acute malnutrition                                                                  

  **Treatment**                                                                                        

  Treatment of patients with severe                                                                    
  anaemia                                                                                              

  Home treatment for moderate acute                                                                    
  malnutrition                                                                                         

  Stabilisation care for severe acute                                                                  
  malnutrition                                                                                         

  Follow-up home treatment moderate                                                                    
  and severe acute malnutrition                                                                        

  Laboratory diagnosis of anaemia                                                                      

  Blood transfusion for severe anaemia                                                                 

  **Others**                                                                                           

  Nutritional surveillance                                                                             
  ------------------------------------ --------- ------ ---------- ------ -- ---------- -- -------- -- ---------

## 2.11 Water and sanitation.

  ------------------------------------ --------- ---------- ---------- -------- ---------
  **Facilities, interventions,         **HHP**   **PHCU**   **PHCC**   **CH**   **CHD**
  services provided**                                                           

                                                                                

  IEC on environmental health, safe                                             
  drinking water, personal hygiene                                              

  Social marketing of devices for                                               
  water chlorination (Water Guard)                                              

  Storage of safe drinking water                                                

  Borehole                                                                      

  Latrine(s)                                                                    

  Covered pit for waste water disposal                                          

  Hazardous waste management                                                    

  Safety boxes                                                                  

  Fenced-in hole for burning solid                                              
  waste and safety boxes                                                        

  Incinerator (exceptionally)                                                   
  ------------------------------------ --------- ---------- ---------- -------- ---------

[^1]: Western Equatoria, Bahr el Jabel, Eastern Equatoria, Northern Bahr
    el Ghazal, Western Bahr el Ghazal, Lakes, Warrap, Jonglei, Unity and
    Upper Nile

[^2]: USAID (2003)

[^3]: 5.9 (JAM), 6.7 (JIS/Sudan Health Transformation Project)

[^4]: SPLM (2004) Laying the grounds for the recovery of the health
    sector in a post-conflict Southern Sudan. SPLM Secretariat. 2^nd^
    Draft, March 17, 2004

[^5]: Assuming a population growing to a maximum of 12 million until
    2011

[^6]: And another name might be chosen

[^7]: Additional space is needed if housing of staff posted from
    elsewhere is considered

[^8]: Alternative: 2 CHWs and one vaccinator

[^9]: Once available, visiting on fixed days from County Hospital

[^10]: Additional space is needed if day care for children of staff and
    housing of staff posted from elsewhere is considered

[^11]: One of them doubling as hospital director

[^12]: For 100 beds, full occupancy

[^13]: The outpatient department (OPD) of the CH functions exactly like
    a PHCC; the OPD functions are therefore not repeated here and we
    refer to table 2.3 above: PHCC Summary. Human Resources calculated
    accordingly

[^14]: Where available

[^15]: Some Faith Based Organizations whose mandate doesn't allow the
    provision of family planning might enter into agreements (consortia,
    sub-contracting etc.) with separate partners for the provision of
    this component of the BPHS.