Reconstruction Aid to National Health System in South Sudan through Development and Training of Local Human Resources

Project location: Sudan, South Sudan
Project start date: July 2012 - Project end date: May 2013
Project number: 2012-062
Beneficiary: AMREF

 [2014-019]

The overall project objective is to contribute to the reconstruction and rehabilitation of the health system of post-conflict country South Sudan, in order to promote lasting improvement in health and life quality of local people. Through the support to the Ministry of Health of South Sudan and to the National Health Training Institute of Maridi - Medical Assistant School Diploma in Clinical Officer - the project aims to provide health professional education and to develop skills and capacity of Southern Sudan health personnel.
The project aims to fill the almost complete absence of a structured and institutional training system creating appropriate health educational standards and criteria. Through the intervention it is expected to support the reconstruction of the health system in South Sudan, increase the access to primary health care services for all the people, and ultimately, improving their health.
The project will be helping lay the foundation for the continuing reduction of poverty and the progress towards the achievement of the UN Millennium Development Goals in South Sudan.
This intervention is meant to be in line with the objectives of the Peretti Foundation as well as with the UN Millennium Goals agenda and the Italian Cooperation guidelines. That is what is mentioned in the guidelines and directions of the 2011-2013 Program of the Italian Development Co-operation of the Italian Ministry for Foreign Affair, where the priority field of intervention (specifically, among the areas of special importance in the G8) is Healthcare. It reads: "Priorities will be represented by a renewed commitment to Global Fund and by the fight against polio and the identification of complimentary actions in the multilateral framework (WHO) and bilateral cooperation to promote the strengthening of healthcare systems and, in particular, doctors' education and health professionals". Furthermore, in view of the above mentioned observations and in view of the fact that three of the 8 Millennium Development Goals focus on health, we can confirm the intervention in line with the three following MDGs: N. 4 Reduce child mortality, N. 5 improve maternal health, N.6 fight against HIV/AIDS, malaria and other diseases.

The intervention aim is to promote a comprehensive development of human resources working in the healthcare field in South Sudan. The expected results and related activities were then designed and developed in this direction. The project represents the continuation and consolidation of existing activities.
Activities will be implemented by local partner (AMREF South Sudan), under the supervision of AMREF Italy.

The main expected results are:
1. Adequately trained and qualified clinical officers (No. 8 students).
2. Development and enhancement of the capacities and skills of the training and administrative staff of the Institute, in managing the Institute and providing services and medical education training.
3. National Health Training Institute of Maridi - School for Medical Assistants - developed, strengthened and adequately equipped.
4. Inform Italian public opinion, both specialized and non, regarding the collaboration with the Foundation, the theme and the overall objective of the project.

Regarding the results, the implemented activities are:

Result 1: Adequately trained and qualified clinical officers
1.1.Selection and recruitment
1.2 Indoor and outdoor training
1.3 Strategic development of the Institute

Result 2: Institute tutors' capacities and skills, developed and strengthened in managing the Institute and in providing services and medical training.
2.1 Training of trainers
2.2 Refreshing trainings for tutors
2.3 Research and development of good practices

Result 3:National Health Training Institute - School for Medical Assistants - developed, strengthened and adequately equipped.
3.1 School Management Board Meeting
3.2 Quarterly meetings of tutors and local authorities
3.3 Workshops on self-evaluation
3.4 Equipment supply
3.5 Supplies and maintenance
3.6 Structural improvement

Result 4: Inform Italian public opinion, both specialized and non, regarding the collaboration with the Foundation, the theme and the overall objective of this project.
4.1 Press conference
4.2 Publishing

Strategy and Methodology
The participatory approach adopted in the intervention is based on the full involvement of local communities and government authorities in general. The beneficiaries of the project cover a central position in the methodology of AMREF action: their needs and necessities are carefully analyzed in order to meet them in full, plus the social and economic context provides additional details necessary to the understanding of all the issues.
a) Intervention methodology: the methodology of work of AMREF is to use three broad strategies: Partnership with the Community, Capacity Building, Health Systems Research to influence policy and practice in health care.

1. Partnership with the Community. From an operational point of view, AMREF's strategy is based primarily on the full involvement of the local community and on an accurate knowledge of the composite reality of the community itself. Therefore the strategy takes into account all the existing differences. The objective of this methodology is the integration of interventions in a given area so that each project will become part of a wider development initiative led by the community.
The Community approach significantly strengthens the impact and sustainability of project interventions. For this reason, and despite the obvious difficulties in the context of civil conflict, the beneficial communities will be encouraged to participate, in partnership with local authorities, at all stages of the project.
In this particular project, involvement of the community will help identify the problems related to health and development within the community, available local resources meeting their needs and solving their problems. Collected data will be used not only to assist communities to plan, implement and evaluate their actions in solving the problems of health and development, but also to update the curricula of the Clinical Officers and ensure that their training would be most appropriate in the context in which they will be operating.
2. Capacity building - The community will be provided of tools which will help them contribute actively in building the capacity of their own community.
The Capacity building is the process by which individuals, groups, communities and organizations extend their capacity to perform basic functions.

Health priority areas - both formal and informal - of the project AMREF will be dealing with are:
1. Improvement of Health Management Information System in the community and its connection with the central system of the Ministry of Health.
2. Development of human resources working in the health care system.
3. Health systems research to influence policy and practice in health care. This project aims to facilitate research and innovative procedures, and consequently to share the experiences and best practices that have shown relevant results and effectiveness in facilitating valid health services dispensation to the community. It is of vital importance for AMREF to verify that development teaching is learned from the work on the field and then replicated, so that a proper advocacy activity may be carried out in the local institutions. Advocacy represents for AMREF the ability to promote and sponsor a cause, use information and other resources strategically in order to change policy decisions as well as individual and collective behaviours. For this specific project, advocacy is meant to influence policy decisions, methodologies and strategies of health care facilities, based on evidence of the results achieved by the project. The beneficiary communities will get stronger as they will ask for respect of their rights and influence the development practices that are specifically conceived for their critical needs.
These methods are based on some key elements:
Genre: AMREF is aware that development processes have a different impact on men and women. AMREF makes sure that the project will involve both segments of the population, in its activities and its strategies.
Consolidation of local authorities. The project includes a significant consolidation and active participation of local administration and authorities and the development of their human capital through training and awareness.
Enhancing and building local expertise. The project provides a significant enhancement of local skills.
Replicate a successful model already experienced. This project aims to replicate an initiative already started up and characterized by the full achievement of the objectives proposed.

The project takes place in the new State of South Sudan, indicated as a priority country in the three years Development Program of the Italian Cooperation of the Ministry of Foreign Affairs 2011-2013.
South Sudan has been recently recognized as a country. It includes ten states that formerly made up the three historic provinces of Bahr el Gahzal, Equatoria and Upper Nile. A secession referendum was held in South Sudan in January 2011. Inhabitants of ten southern states went to the polls and independence has been declared with more than 99% votes in favour of secession from the north.
The South Sudan case is emblematic: after more than twenty years of bloody war between Southern Sudan and Karthoum government in the North, thanks to the agreements signed in 2005, it seemed that the country was in the right process towards peace. In spite of the formally declared independence of July 2011, the new republic of South Sudan is almost like a ghost-country: infrastructures are almost virtual, schools, hospitals, administration buildings have been almost completely destroyed by the war. All those who had the chance to leave, they did. The result is that today a population of about 8 million people lacks essential services and trained staff to start the reconstruction.
Destruction of social and administrative infrastructures represents therefore the most visible aspect of the socio-economic collapse. In particular healthcare services are absent and the only few existing and operating are almost entirely due to the efforts of humanitarian organizations.
Health indicators show that the estimates, according to parameters related to the Millennium Goals in South Sudan, are substantially worse than the average of sub-Saharan Africa. It is estimated that the healthcare personnel present in South Sudan is composed of less than 8,000 people (including only a few hundred doctors), far below the threshold of 17,300 workers that would be needed to provide adequate health services to the country's population which is estimated to be about eight million people (not counting the three million refugees who left the country during the conflict and whose return is progressively expected within the next few years). According to the latest "Report on the tracer study of the graduates of the NHTI South Sudan "(February 2009):" there are three levels of health services in South Sudan - hospitals, Primary Health Care Centres (PHCC) and Primary Health Care Units (PHCU). The network of health services can count on approximately 699 hospital structures: 19 hospitals, 106 PHCC and 574 PHCU. It is hard to manage and operate these facilities which have, according to the analysis of 2005 regarding the situation of the so-called "health workers" (health professionals of different levels), a severe shortage of qualified health personnel to provide the needed health care services. Because of this situation, it is of vital importance for the Government of South Sudan to focus the efforts of managing basic and medium level training for medical workers.

This project was renewed in 2014 for a duration period until December 2016..