Improving the health of vulnerable women, adolescent girls, and children in South Sudan

In 2016, BRAC successfully delivered a project in Juba (Luri county), South Sudan with the aim of improving the reproductive, maternal, new-born, and child health (RMNCH) of vulnerable women, adolescent girls, and children. Despite facing some unexpected difficulties, in which lessons can be learned for the benefit of future projects, the project has performed exceptionally well in difficult circumstances.

In Juba, BRAC used a grass-roots level approach to not least strengthen the understanding and access to sexual and reproductive health rights and information, but also sought to improve the provision of RMNCH health services available and raise greater awareness of sexual and reproductive health rights.

The project’s key activities focused on:

• Training 120 Community Health Promoters (CHP) to provide door-step RMNCH information, services and referrals to government health facilities. CHPs also successfully set up community health awareness sessions and ‘mother to mother groups’.
• Training and equipping 4 Mobile Nurses in order to facilitate health extension services in the most remote, hard-to-reach communities.
• Developing a network of 120 Youth Health Mentors who provided health and life skills messages targeted specifically at youth through Youth Health Forums.
• Conducting advocacy meetings with community leaders and government officials to encourage and promote utilization of RMNCH services by women in their communities.

The main focus and ultimate objective of BRAC UK’s project in South Sudan centred on improving the provision of RMNCH. Despite conflict arising in Juba on 8 July 2016, this core focus remained unaltered throughout the course of the program delivery. The conflict severely compromised BRAC’s ability to implement the project activities, thus leading to the downscaling of the scope and scale of the project size. Though the original target of primary beneficiaries to be reached was set at 90,240 women and 5,760 girls of reproductive age and 13,440 children under 5, the target was revised to 20,000 women and 5,000 girls of reproductive age and 9,000 children Under the age of 5 (23% of the total population) following the conflict.

Despite being downscaled, the project actually exceeded revised target expectations successfully ensuring that 24,076 women and 12,374 adolescent girls had enhanced access to appropriate RMNCH information; 13,888 children under five were seen by Mobile Nurses & Community Health Promoters, and 5,400 Children under 5 were referred to health facilities for treatment.

Although the project surpassed expectations, the implementation was still met with some challenges:

• Conflict: On July 8 2016, as already highlighted, conflict arose in Juba severely compromising BRAC’s ability to implement the project activities. In July, BRAC activated its Crisis Management Plan, and so suspended its operations and even temporarily evacuated staff from Juba and other areas to Uganda. This made it challenging to smoothly implement the activities, with no oversight and monitoring from July 2016 – Nov 2016. A re-design of the project followed, reducing the scope to one county, Juba, but still ensuring the key RMNCH focus.
• Treatment of diseases: There was also some difficulty in meeting the additional needs relating to the treatment and assessment of diseases such as malaria, pneumonia and diarrhoea. Though, to meet these demands, BRAC UK collaborated with the activities of the BRAC Integrated Community Case Management (ICCM) program.

Having said this, it is clear that even in the face of the challenges met along the way, the project can still be considered a great success. In fact, on delivery of the project, a total of 174% of beneficiaries were actually reached.

On completion of the project in Juba, the BRAC team collaborated with government stakeholders in establishing more effective government health facilities, for example, opting to train local staff and equipping them with the appropriate tools, rather than directly implementing the project ourselves. This is just one way we hope to ensure the long-term sustainability of the project in South Sudan for years to come. Though with this, has come the bravery of our colleagues in Juba who continue to deliver the project, despite the danger to their own lives. Without them, the results of this project would not have been possible.

Written by Suraiya Rahman