Increasing access and strengthening capacities of PHC to provide emergency lifesaving health care services in Fangak and Nyirol counties through the provision of 2 mobile units, 5 PHCUs and 1 PHCC including Integrated response The emergency this project will address is the rising rate of mortality and morbidity attributed to limited access to PHC services, weak capacity to deliver essential clinical and emergency lifesaving health services. Main diseases are malaria, AWD, pneumonia, SAM with medical complications and measles, cholera and kala-azar and epidemic prone and vaccine preventable diseases. The project locations are in former Jonglei State in Nyirol and Fangak counties with total populations of 169,493 and 210,383 respectively. In Nyirol, the project catchment area has a population of 75,747, broken-down as follows: 6 years and older 28,723 males, and 31,117 females and 7,635 boys and 8,272 girls. In Fangak project catchment area has a population of 54,207 broken-down as follows: 6 years and older 20,555 males, and 22,268 females and 5,464 boys and 5,919 girls. With a total project budget of $200,000 an estimated $116,000 (58%) is for Nyirol and $84,000 (42%) is for Fangak. The project will target 26,317 direct beneficiaries (Men 7,700, Women 8,388, Boys 4,851, and Girls 5,378). Coupled with indirect beneficiaries, a total of 69,988 will be host communities while 23,211 will be IDPs.
In targeted counties health issues have been compounded by hunger and malnutrition which have escalated with conflict continuing to disrupt the cereal markets. According to FEWSNET outlook (June-Sept 2018), Fangak and Nyirol are among the counties at risk of having households slump into Catastrophic (IPC Phase 5) soon. A SMART survey conducted in Nyirol in March found a GAM (WHZ) prevalence of 25.7%, close to the Famine threshold of 30%, and a SAM (WHZ) of 6.6 %. The Crude Death Rate was 1.70, with % of deaths due to trauma unknown. In the same survey, 4.1% of households reported severe HHS and 77% reported moderate hunger. According to HC bulletin April 2018, timeliness and completeness were 57% amp 74% at county level for IDSR reporting and 71% amp 74% at the HF for EWARS/IDP reporting respectively. Common NCDs observed included Cardiovascular (5%), Eye diseases (55%), Dental/Mouth (13%). According to WHO report (Feb 2018), though the third dose of Pentavalent vaccine coverage increased marginally from 45% in 2016 to 57% in 2017, the coverage for areas seriously hit by the crisis has remained at 16%. 

In Nyirol, the clinical packages will be PHCU from 3 sites and 2 mobile units. In Fangak, the clinical packages will be PHCU from 2 sites, and 1 PHCC and 1 integrated response from Juaibor PHCC. The PHCC will provide SAM with MC, BEmONC, MPHSS and CMR for victims of SGBV, MH, and NCDs on outpatient and inpatient basis. For the integrated response in Nyirol, the components adding to health will be nutrition (conducted by CMA integrated with health) and through colocation with other humanitarian actors, FSL and WASH will be integrated. Further, through community education campaigns FSL and WASH messaging will be fully integrated with health and nutrition messaging.

The project will address cross-cutting themes specifically: mainstreaming gender equality ensuring there is AAP and protection of vulnerable populations so they can access health services. The economic and political crisis remains the most significant risk to service disruption. CMA will manage this risk by: (1) ensuring mobile units are equipped to provide services when insecurity limits access for re-supply and support (2) maintain a one month inventory of essential medicines and supplies (3) maintain good relationships with local authorities best placed to provide security of personnel and supplies in an emergency. Integration will be achieved by collaborating with other humanitarian actors delivering FSL and WASH. CMA has PCAs with UNICEF for health and nutrition programming. The integration of health services with nutrition programming allows maximum impact from available funding as both programs target same locations, and use common facility, transportation and human resources.