Emergency healthcare delivered through the PHCC, PHCU, Mobile Teams and iCCM packages targeting vulnerable and unreached host communities where IDPs are integrated in Fangak and Nyirol counties of former Jonglei State. The emergency that this project will address is the high rate of mortality from malaria, AWD, pneumonia, SAM with medical complications and outbreaks of measles, cholera and kala-azar. In the volatile context of GUN, the project will target IDPs recently displaced and newly displaced by conflict, and IDPs and host communities in PHCU locations without health services. Nyirol is rated as IPC 4 Emergency for February to May, but expected to deteriorate (IPC SS Oct 2017, FEWS Net, pg7). Catastrophic (IPC Phase 5) remains likely in parts of Nyirol, where households did not harvest and ongoing insecurity is limiting access to assistance and movement towards natural food sources (FEWS Net January 2018).

Two clinical packages will be delivered: PHCU and mobile teams for emergency outreach. A third package, the PHCC package for the treatment of SAM with medical complications and CMR will be delivered at one PHCC (Pultruk) with established stabilization center. To address access, coverage and service interruptions, the project will support: (1) case-finding medical outreaches from PHCUs to reach vulnerable HHs and conduct surveillance (2) emergency mobile teams to reach locations without PHCU services and to serve new and recently displaced people (3) one selected PHCC for the stabilization of SAM and CMR as well as referrals of patients needing specialized services for HIV/AIDS, TB and MPPSS. The project will provide skilled health workers for the PHCUs, mobile teams and PHCC-based stabilization centers, and provide support to conduct the outreaches to bomas not served by static facilities, and for mobile team outreaches in an emergency. The project will provide equipment, supplies to maintain services from PHCU facilities and add transportation for implementation of emergency mobile team outreaches.

Estimates for Nyirol show 49,335 IDPs as of October 2017. Recent conflict in Waat where the population has been displaced to Keew has raised the displaced population by at least 16,000 according to local authorities and CMA’s on-ground teams.

Data from the fourth quarter of 2017 indicates the leading causes of morbidity were: malaria, diarrhea and pneumonia (CMA HMIS Data October-December 2017). During 2017, 3 cases of cholera were confirmed and 6 other cases were suspected. Nutrition Cluster data shows a GAM rate of 25.7 for children U5 and 35.2 for PLW. The increase in SGBV has heightened the need for CMR for the survivors of rape.

The project will fill the critical humanitarian gap of lack of access to frontline lifesaving healthcare services for the most vulnerable children U5, and PLW of newly displaced and unserved IDP populations. To address this gap, PHCU and mobile team clinical packages will be scaled-up along with stabilization center services to treat SAM with medical complication at Pultruk PHCC.

Project objective 1 aims to improve access to healthcare for conflict-affected populations with emphasis on malaria control, AWD and pneumonia. Project objective 2 aims to prevent, detect and respond to epidemic prone disease outbreaks especially kala-azar, measles and cholera through both static services and emergency mobile team outreaches, including surveillance to detect new outbreaks. Emphasis will be on preventing infection, water quality and waste management when delivering cholera treatment. 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 women and adolescent girls including essential CMR services. 

An estimated 14,286 outpatient consultations will be achieved, of which 4,143 will be children U5, and 1,142 PLW women. 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 are not impeded when access to services is needed.