Strengthening the capacity of life saving emergency primary healthcare services integrated with SAM services and including clinical management of SGBV in Fangak of Jonglei State. The project will be implemented in Fangak County rated as Severity of Need Level 5, for health needs (SS HNO 2017, UNOCHA pg 10) and IPC 3 Crisis (IPC SS February 2017, FEWS Net, pg 3). CMA’s experience in Fangak shows only 24% of facilities are delivering services. Four PHCCs (Juaibor, Keew, Nyadin, Pakan) plus one hospital (Old Fangak) reach only 46% of the total population and cover 57% of IDPs. Data for the final quarter of 2016 indicates clinical treatments were: 46% malaria, 14% diarrhea and 6% pneumonia, and data from Nyadin PHCC in Mareang payam showed 6 deaths of U5 children and 8 maternal deaths (CMA HMIS Data Oct-Dec 2016). CMA’s data shows 10 cases of suspected kala-azar in Pakan, New Fangak payam and 15 cases of suspected cholera treated in Paguer and Manajang payams so far in 2017. February 2017 data of screening children U5 in Paguer and Manajang payams showed a proxy GAM rate of 38.2% (12.1 SAM, 26.1 MAM) with increasing incidence of SAM with medical complications. The rise in SGBV has heightened the need for comprehensive care for the survivors of rape.  

The critical humanitarian gap that needs to be filled is the lack of access to lifesaving primary healthcare services for the most vulnerable U5 children and PLW of unserved IDP populations. Health Cluster estimates for Fangak show a total of 76,200 IDPs of which CMA estimates 46,460 have settled in the payams targeted in this project. Targeted areas comprise an estimated 65% of the total population of Fangak, and 61% of the IDP population.  

Project objective 1 aims to improve access and scale-up in emergency responsiveness to an integrated primary healthcare package focusing on the major causes of mortality among U5 children (malaria, diarrhea, pneumonia, measles) and SAM with medical complications, and emergency HIV/AIDS, TB referrals and BEmONC focused on PLW.  CMA expects to reach 21,319 individuals of which 58% will be IDPs, and the most vulnerable U5 children 7,392 and PLW 3,616 individuals.     

Project objective 2 will deliver emergency response to epidemic prone disease outbreaks targeting kala-azar, measles and cholera through both static services and mobile medical outreaches, including surveillance to detect new outbreaks. The targeted individuals directly benefiting from these interventions is 2,296.

Project objective 3 will improve access to essential clinical health services that are inclusive and implemented with dignity and targeted to the specific needs of vulnerable populations (women and adolescents) by offering essential SGBV and clinical management of rape services.  And project objective 4 will improve access to MHPSS for the vulnerable people by providing psychosocial support and mental health services for the highly vulnerable population. A total of 100 individuals are expected to directly benefit from these services.

The project will provide skilled health workers to deliver static services and conduct the medical outreaches to bomas not served by static facilities. The project will provide equipment, supplies to maintain services from static facilities and add transportation support (boat hire for long distance outreaches and walking for short distance outreaches) to enable mobile teams to serve unreached areas. An estimated 53,752 outpatient consultations will be achieved, of which 14,785 will be children U5 years including 136 receiving treatment for medical complications related to SAM. A further 22,470 people will be reached with health education and promotion messages. To ensure the project achieves gender equality in access to health services, communities will be organized to provide protection for vulnerable women, adolescent girls and children so they can access services. Through outreaches to PHCU and other locations where IDPs have concentrated, a large unserved population of IDPs estimated at 12,365 people will be reached.