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
South Sudan has witnessed the longest liberation war of modern Africa. The conflict, which began after Sudan's independence in 1955, ended with the signing of the Comprehensive Peace Agreement (CPA) in January 2005. The civil war destroyed most of the infrastructure and social fabric of the region. Following the signing of the CPA, which provided for a transitional period of six years, the Government of South Sudan was established on July 9, 2011 thanks to a self-determination referendum that saw more than 98% of South Sudanese vote in favor of secession. Hopes for South Sudan's renewed growth and development, which after the signing of the CPA had appeared to become a reality, have been dramatically unheeded. Today, also in light of recent events, the country is one of the most underdeveloped in the world. In 2014, the United Nations Human Development Index ranked South Sudan 166th out of 187 countries, due to indicators such as the literacy rate and access to clean water. One the most serious consequences of the general instability that characterizes this ‘post-conflict' reality is the collapse of the national health system, as demonstrated by the maternal mortality ratio (2,054 deaths per 100,000 births), the infant mortality rate (75 per 1,000 births), and the child mortality rate (105 per 1,000). In addition to a crumbling infrastructure and missing services, the key emergency aspect is the health personnel crisis. In fact, it is estimated that less than 8,000 operators qualify as skilled health personnel: well below the minimum threshold necessary to provide adequate health services to a population of 12 million people. Of these 8.000 workers, only a small percentage are women, a further factor influencing the overall development of the country.
Therefore, a key priority for South Sudan remains the training of skilled health personnel; and it is in this context that the project takes place.
Activities and means deployed
Result 1: Properly trained and qualified South Sudanese health care personnel
1.1 Selection and recruitment
Due to a series of events that severely tested the country at the end of 2013, the beginning of project activities has been postponed, and activities were formally launched on 1 April 2014, with a slight delay compared to the work plan and academic year. In light of the political tensions, the selection and recruitment process for the new Intake began in April 2014. The months before were dedicated to dissemination information with radio messages, advertising and meetings at the Ministry of Health on the training opportunities offered by the Maridi Health Science Institute. A committee of ten members, representing all states that make up the Republic of South Sudan and appointed by the Minister, then met at the Ministry of Health headquarters in Juba to review the applications.
The selection criteria used to draw up the list of new students admitted to the first year of the Clinical Officer course were the same as in the past:
o South Sudanese nationality (with residence in South Sudan and / or neighboring countries)
o Certificate of upper secondary education
o Basic understanding of science (mathematics, biology...) and English
o Prior work experience in the health field and / or qualification as Community Health Worker
As always, priority was given to female candidates representing the 10 states. Due to the aforementioned delays, the final list was shared with Health Amref Africa only in April 2014. The following month was dedicated to compiling and submitting the list, and then calling the selected students, who were finally able to begin their courses in June 2014. The first three months of operations were used for meetings with stakeholders to agree on the selection list, communication strategies, and the final student selection.
The course is structured around two main elements: theoretical training (indoor) and field practice (outdoor). It focuses on the development of essential medical assistance capabilities and skills.
Indoor: The academic year began in February 2014, with a considerable delay compared to the work plan, according to which it was set to begin in the first week of January 2014. Second year (Intake 19) and third year (Intake 18) students, due to the internal instability of the country, faced serious difficulties in reaching the Institute. In June 2014, Intake 18 and 19 students were finally joined by their first year (Intake 20) peers: 30 new students joined the 61 already installed. All students were provided room and board, a small monthly allowance (called "salary"), medical treatments, linens, uniforms, and clinical tools for practical lessons, textbooks and miscellaneous supplies.
The program is aligned with the national curriculum (no revisions were carried out after 2012), and features both theoretical lectures and practical activities. The academic year is divided into two semesters, of 660 hours each, which continued without any further interruption until November 2014. Lectures took place each week, Monday through Friday (excluding holidays). First year students, having started with a six-months delay, did not complete the curriculum on time. For this reason, Intake 20 is expected to complete the 1st year program in June 2015.
During the first half of the year, Intake 19 students engaged in the following subjects: epidemiology and bio statistics, communicable diseases, pharmacology, health services management, and mental health. The second half of the year included: pathology, ophthalmology, ear, nose and throat, introduction to medicine, introduction to surgery, introduction to pediatrics, and introduction to gynecology and obstetrics. Intake 18 students studied pediatrics, obstetrics and gynecology, medicine and public health in the first semester; while in the second half of the year, they were mainly engaged in practical activities. Finally, Intake 20 students, having began their classes in June, studied during the second semester the classes scheduled for the first: IT, communication, anatomy and physiology, social and physiology, nutrition, professional ethics, community public health, and basic community health care.
During 2014, the students faced interim evaluations (in July and October 2014) via the administration of Continuous Assessment Tests (CATs), which serve to assess their level of learning. The CATs were presented in the form of multiple choice, open answers and short compositions written tests. The results contributed to 40% of the students' final evaluation, and are instrumental to graduate the year, and, for third-year students, the course.
Final exams, the results of which contributed to 60% of the final score, were carried out on November 3-7, 2014. The final examinations session took place at the Yei Examination Centre. This was followed by an administrative verification phase, which took place in Maridi on November 10-15; while the evaluation phase was carried out between November 17-20; and the final results were finally released on November 21. Costs related to the entire exams session include: a fee to be paid for each student to the examination committee, daily allowances for tutors, and logistics costs (transport, accommodation and meals).
At the end of the final exam session (this year the graduation ceremony did not take place, as it is held in alternate years), all students returned to their communities of origin.
Finally, the new year was inaugurated in January 2015, when Intake 19 (third year) and Intake 20 (first year) returned for their classes. Because of the aforementioned delays, Intake 20 students are set to finish their first academic year in June 2015. This year, as the previous one, due to ministerial delays, the selection of new students has took place in March / April 2015, and the new Intake (21) will begin attending the Institute in June 2015. This time, the wait was caused by a lack of adequate financial resources to enable the start of the new training cycle, not only at the Maridi Institute but in all national training institutes attached to the government. Indeed, resources were blocked and channeled mainly to support the precarious situation that continued well beyond December 2013.
Outdoor: As always, the three-year cycle of the Clinical Officer Diploma includes, throughout the academic year, several practical activities to exercise what was learned in the classroom.
From March 2014, second year students began a short training course at the Maridi Hospital. These activities include: medical history, identification of diseases, prenatal care, outpatient care, pediatric care, and support in the lab analysis.
In May 2014, third year students spent a month at the regional hospital in Maridi, both a partner and beneficiary of the intervention. Students, under the guidance of qualified personnel, carried out a good part of Hospital's basic work. In fact, the local hospital suffers, as the entire nation, from a severe shortage of skilled health personnel. It is in this sense that the project will achieve the overall objective, contributing to the strengthening of the national health systems. Once qualified, the trained personnel will return to their communities of origin, giving back what they have learned at the Institute. Third-year students actively participated in the daily management of the Maridi Hospital, and under the supervision of tutors carried out medical histories, diagnoses, and prescribed medications and appropriate care to patients.
First year students were also able to fulfill their practical activity in support of the community, implementing community diagnosis exercises, which consist in the identification of a community near the Institute and in the study of its public health profile. Once these activities were completed, the pupils produced a report, subsequently evaluated by the tutors and taken into account for their overall evaluation. Furthermore, first year students contribute to the construction of basic infrastructure such as latrines and basic sanitation systems.
1.3 Strategic Development of the Institute
The Maridi Institute, in light of the formal changes that shook South Sudan, embarked on a progressive strategic review plan to make its services as accessible as possible to all states in the country. The process was launched in 2012, but remained incomplete until October 2014 when the Five-Year Strategic Plan (October 2014 - September 2019) was formally approved and published. Among the various changes, there is also the new name of the Institute: from National Health Training Institute to Maridi Health Sciences Institute. The change was dictated by the need to reconcile the Institute with its local roots (located in the state of Western Equatoria). The Strategic Plan was developed in a series of workshops held in Juba with the Institute's main partners; the first draft saw the collaboration of team of experts who collected relevant data from the field, with the aim of improving the Institute's educational performance. Given the information they had gathered, the team highlighted 5 weakness elements and a framework from which to develop the five-year plan. During a last consultative meeting, a number of actors directly linked to the Institute (representatives from the Ministry of Health, Humanitarian Agencies and other partners) were asked to evaluate and share comments and recommendations from different perspectives. Their feedback was duly noted and ratified. The five strategic objectives (answering in part to the 5 elements uncovered by the team of experts) are summarized as follows:
(1) Improve, both qualitatively and quantitatively, the Institute's administrative skills;
(2) Improve and strengthen the communication capacity to and by the Institute and increase the administrative support staff and administration capacity to enhance management efficiency;
(3) Support the Institute by upgrading facilities to increase reception capacity without compromising quality;
(4) Increase the internal fundraising capacity to increase the Institute's independence and sustainability;
(5) Diversify the training courses, in line with the Institute's identity and history, to maximize impact at the national level.
The full strategy document is attached.
Result 2: Strengthened service delivery and capacity through the structural improvement of the implementation site and staff skills
2.1 Structural improvement and expansion
The project covers the structural improvement of the Institute. Specifically, for the period under consideration, the following activities were programmed: the realization of a well and adjoining connection to the water system; the realization of anew sewage system; and the construction of a dormitory. The technical details of infrastructural activities are included in the detailed reports by the Director of the works.
a) Well and connection to the water system
The construction of the well for the Maridi Institute was entrusted to a private company (which won the tender according to local procedures). The work was completed in December 2014, and an achievement and operation certificate was issued to the contractor, while payments were verified according to the contract's requirements. Activities began with a preliminary check of the site and a water analysis to ensure its potability: a first drilling 15 meters from the main building came back negative; after a second test (also unsuccessful because of loose soil), a third drilling was successful thanks to the Supervising Engineer's work, which guaranteed water potability. After reaching the required depth (117 meters), a submersible pump was installed; a protective structure in steel was then built upon the pump to protect it from vandalism and theft. Once the well was completed, two storage tanks with a 5,000-liter capacity were mounted on a 5-meter high steel base. Finally, a 107-meter connection between the tanks and the existing water supply was built. Prior to the issuance of the achievement certificate, the configuration was extensively tested. Today, the presence of the well and the subsequent connection provides water to the Institute.
1) Well successfully drilled
2) Pump able to withdraw water from the well at a speed of 4-5 m3 / hr installed
3) Storage tanks with 5.000lt capacity installed over a 5-meter high steel frame
4) Steel structure to protect the pump from theft or damage duly installed
5) 107-meter long connection to the existing water supply built
The system was finalized and payment successfully completed.
b) Construction of a new sewage system
The construction work for the septic tank was entrusted to a private company (which won the tender according to local procedures). The work was completed in March 2015, when a certificate of achievement was issued to the contractor, while payments were verified according to the contract's requirements. The work also calls for the construction of a connection pipe to the sewerage system and the pre-existing dormitory.
The first plant of the pit collapsed in part because of a technical error and poor design. After the partial collapse of the septic tank, the construction manager proposed a new analysis and recommended improvements to the design. These improvements were necessary to ensure the structure's stability. The recommendations were:
1. Inclusion of a perimeter beam inside the walls to strengthen the perimeter against the soil pressure on the walls;
2. Inclusion of a perimeter beam beyond the wall to anchor the plate to the edges of the wall;
3. Inclusion of three beams under the central plate to provide extra support, also in light of future periodic activities to empty the septic tank.
c) Construction of the female dormitory
The dorm is designed to accommodate 48 bunk beds for a total of 96 students, both present and future. At the end of the first year of the project, on 31 March 2015, the property was partially completed: the perimeter walls, the roof, the internal subdivisions, and bathrooms were functional. The connection to the existing sewerage system and septic tank was delayed due to some misunderstandings with the contractor and because of the difficulty in finding raw materials and assembly parts (such as frames for the windows). This slowed down operations and caused delays. However, in such an ordinary and extraordinary context, delays are physiological and in this case they were really marginal considering the overall work plan.
2.2 Research and development of good practices
The research and development of good practices is common in all of Amref's interventions and it wants to develop, test and promote appropriate health improvement models through the application of scientific methods. This project aims to facilitate ongoing research that can support the effective delivery of health services to communities. Research and data collection activities were carried out in parallel to the implementation of the training courses, as it is integrated in the assessment activities regarding the impact of the intervention. Assessment activities also look into the professional development of the Institute's Clinical Officers in South Sudan, their level of preparation in carrying out assigned duties, and the level of satisfaction of the communities they serve. The data is yet to be processed, but a series of papers will be elaborated by the end of the biennium.
2.3 Training of Trainers
To expand and improve the technical skills of the Institute's teaching staff, this year two teachers engaged in a training course. The two tutors that participated were: Charles Aciek Deng, historic teacher for the school who enjoys the respect and authority among students and the rest of the faculty; and Dr. Mustafa Ahmed, a promising new teacher who is mainly in charge of student supervision during their practical training at the hospital. Both traveled to Kenya between August and September 2014, and attended a short but intensive training course for staff already active in Community Health. The course, held at the Amref Health Africa training center in Nairobi, included the following modules:
- Introduction to human resource management in health
- Human resource planning in the health sector
- Personnel selection and recruitment
- Health personnel training
- Health and Safety
The project supported all expenses, transportation, room and board, and participation rate costs as well as supplementary repayments for the tutors.
2.4 Quarterly meetings of tutors and local authorities
On a quarterly basis, slightly pushed forward due to the aforementioned delays, the training staff and administration of the Institute met four times with hospital operators and representatives of local authorities involved in the ordinary and extraordinary management of the Institute. The objectives and agenda of the meetings were fixed on the basis of the quarter's priorities: during the first quarter, the focus was on welcoming the new Intake, and the related verification of adequate housing, uniforms and textbooks purchases, as well as the verification of the budget and its parameters and margins. Discussions centered around how to match the year's academic performance with the differences between the second and third year courses and the first year course, without increasing the cost of business operations. During the second and third meeting, the debate focused on the daily management of the Institute and preparation for the final exams (the third quarter coincides with the October-December 2014 quarter, a defining moment for the school, which closes at the end of November after the final exams). In particular, during the third quarter, the staff was engaged mainly in the verification of the CATs and in the preparation and definition of the final exams. The last quarter (which from an academic perspective coincides with the first quarter) focused on the reception of students, the evaluation and completion of structural work, and the supplies inventory (beds, computers, books, stationery, clinical tools, etc.) to verify the needs of the project and prepare the funds' call down.
2.5 School Management Board Meeting
In the months of May and October 2014, two meetings brought together various institutional representatives of the Institute's stakeholders: in this case, discussions focused mainly on the curricular content, and specifically on the management of student selection and the general situation of the country. Undoubtedly, the main critical element was and still remains the general insecurity level; although it does not directly affect the state of Western Equatoria, it significantly influences the activities of the Institute as well as the mood of civil society. A topic of discussion was also the return of the students to the Institute and the stories they told upon their return: in fact, for some of them returning was a perilous journey across unstable areas of the country. The Dean of the Institute, Patrick Taban, suggested leaving a margin of tolerance for the dates of return, to ease the pressure on the students. Taban replaced Lou Eluzai as Dean, as the latter resigned in the previous six months, leaving the Institute in a state of general confusion. Patrick Taban took over the leadership of the School Management Board Meetings with the right authority, considering his previous role as Tutor of the Institute. The second meeting, which took place at the end of the courses, focused on the results of the CATs and the final exams preparation: this monitoring element, proposed by the Board, will be taken into account for the data collection and the definition of good practices. Another element on the discussion table was the delays and scarce financial resources allocated by the Ministry of Health to the selection and therefore the training of health personnel within various educational institutions. This issue is relevant in light of the new Maridi Institute strategic plan, which provides for a significant increase in local capacity for self financing and fundraising, to gradually become less bound to external funding.
This, considered a big step forward in terms of intervention sustainability, needs to be supported by the institutional, financial and operational partners of the project. Meanwhile, cost reduction and efficiency processes have been put in place, resulting in a significant decrease in structural costs (in particular, the Institute cut the transportation costs related to student mobility to and from their communities of origin, as it was considered too demanding a cost, and partly referable to the local authorities of the states of origin).
2.6 Equipment Supply
This year, the budget provided for the purchase of a motorcycle, made possible in September 2014 after the successful preliminary management within the procurement committee. Computer equipment of various kind was also supplied to the Institute:, a computer, memory cards, extensions, adapters and other partial elements. The program, due to climatic conditions (alternating dust and rain, depending on the season), calls for the continuous replacement of computer equipment.
With regard to training and student reception, the following purchases were made: medical kits, uniforms and linens for new students, clinical tools for practical classes (indoor and outdoor), and textbooks, the purchase of which resulted difficult given that the required textbooks were not available on the national territory. Thus, the same supplier as the previous year was contacted, via a local retailer that receives supplies from Nairobi.
Food was provided through the monthly purchases of fresh (fruit and vegetables, meat and eggs, and milk) and dry goods (dried beans, various flours, salt and spices...). The precarious situation (whether only perceived or real) triggered a vicious cycle of price increases for basic services and materials. Consequently, boarding costs soared. In this case, the budget did not allow for an increase in moneys spent, and thus less fresh foods were purchased and the scheduled purchase of bunk beds was not carried out.
2.7 Supplies and maintenance
For the realization of the project, in addition to the motorcycle, the following means of transportation were adopted: pick up trucks (of which the school is equipped - 2), and a bus for students. Gasoline was bought to guarantee the use of said means, as well as oil for the management of the school generators. However, it is worthy of note that the school is equipped with an electrical system connected to the national electrical grid, an almost unique and extraordinary element that makes Maridi a futuristic place compared to the rest of the country. Gasoline and electricity are therefore, together with water, key elements in the Institute's management. With the construction of the well and the water connection, water supply should become less expensive; in line with the Institute's strategic plan.
External factors and other problematic elements
External factors and general problematic elements.
The situation depicted at the beginning of the report remains emblematic of the country's evolution, of the project's centrality and objectives, also in light of the recent political events that led to the further deterioration of an already complex situation. In December 2013, the country's stability was put to the test once again. The President of South Sudan, Salva Kiir, and Riek Machar, the former Vice President, considered today the leader of the rebel forces and hostile to the president, began a bloody struggle for power that brutally divided the country. On 1 February 2015, in the Ethiopian capital of Addis Ababa, the two signed a document entitled "Areas of Agreement" that called for a future national unity transitional government, and a definitive ceasefire, which would counter the frequent violations of the previous agreements, and promised to sign a definitive agreement. The Intergovernmental Authority on Development - IGAD, the regional body that concentrated its efforts - with little success - to end the civil war, described the agreement as a major step towards the drafting and signing of a new Comprehensive Peace Agreement (CPA). This event was supposed to represent a fundamental step to allow the conduct of the project's ordinary and extraordinary activities in a less precarious context. Unfortunately, once again, the violent episodes that are afflicting the country are a critical external element that affects and will continue to affect the project's activities.
On top of this, the scarce financial resources allocated by the government to health personnel training is a serious element that will undoubtedly affect the gradual handover process and the exit timing of the various financial stakeholders. The sustainability section introduces innovative factors that should stem the national authorities' inaction. Unfortunately, the Ministry of Health has no bargaining power, as decisions are taken at the political level. As long as the truce does not prove to have a solid base, funds will be managed by the Ministry of Budget. Until then, the Maridi Institute will still rely primarily on external funding.
Economic and financial sustainability. The project wants, through continuous lobbying, advocacy, and local communication, to guarantee that authorities make available the human and material resources necessary to give continuity to the intervention once Amref's presence and mobilized resources begin their phasing out. Unfortunately the country's potential stability and development have been strained by recent internal fighting, resulting in a governmental economic and financial crisis. Over time, the local authorities have gradually taken charge of specific tasks by providing tools and resources, and the goal today is to ensure an institutional will to continue the gradual handover of activities. Within the current socio-economic situation, the handover has been slow down and in part held back, as the authorities cannot ensure the progressive coverage of all costs. The next three years are thus crucial with regard to a gradual phasing-out for Amref, who will continue working with local stakeholders to confirm this goal is pursued and achieved.
Institutional sustainability. The collaboration between Amref and the Sudanese government dates back to 1972. Over the years, the partnership has been consolidated and expanded to different levels of public health interventions. In a constantly changing scenario, Amref has been able to identify the main needs of the local communities and has been able to intervene with the right effectiveness. Specifically, this project was developed by Amref and the Government of South Sudan and the Ministries of the State of Western Equatoria with the aim of starting a process that will allow for the organization's gradual exit from the intervention, whilst guaranteeing its continuity over time (as evidenced by the recently-signed MoU with the Ministry of Education of Western Equatoria). The collaboration with local institutions wants to contribute to the project's future sustainability, allowing for the absorption of activity costs. Over the course of 2014, the five-year strategic plan that includes the progressive increase of the local fundraising capacity, along with a gradual reduction of structural costs, has been defined. This element, which needs to be supported, is the most obvious step toward the Institute's affirmation as an independent entity.
Socio - cultural sustainability. Amref's interventions are characterized by a great degree of community and institutional participation to ensure a smooth transition towards ownership and future sustainability. The project's vision is thus aligned with all of Amref's interventions. In this case, students and tutors hold a dual role: they are both direct beneficiaries of the project and multipliers within their communities of origin. The degree of responsibility and participation is very high, as demonstrated by the traceability studies carried out over the last five years, which show that a very high percentage of the Institute's graduates operates as a qualified Health Worker in health facilities inside South Sudan. Given Amref's vision, itsmission in Sudan has been since 1972: "to contribute to improving health through the active involvement and strengthening of communities, local staff and health systems." The project is implemented by Health Amref Africa in South Sudan, an essential part of the Amref Health Africa Family. Established 50 years ago in Nairobi, Amref Health Africa is the only non-governmental health organization with headquarters in Africa, and 97% of the staff is African, guaranteeing great geographical and sectoral experience.
MONITORING AND EVALUATION MISSIONS:
1) First mission: 1-18 October 2014
Objectives of the mission and activities:
- Evaluationof the financialplan:
- Verification of the registry and the first collaborationnotewith the local representativesof the DepartmentofFinance
- Informationofdonorprocedures,training of local staffwithin the departmentoffinanceand administration
- Analysisof the project's administrative-financial strengthsand weaknesses
- Studyof the expenses registration system
- Interviewswithadministrative staffdedicated to the project
Conclusions and recommendations:
The expenditures recording and the verification of the financial and administrative progress were possible and effective thanks to the presence of Amref's aid worker, Anna Montagna. Montagna's presence proved indispensable for the data reconciliation process, and it was decided to establish a moment to share expertise on the topic with the local counterpart. This training phase would focus both on institutional procedures and on other recording and cost allocation systems. The aid worker's presence was strongly requested to ensure that this knowledge and skills transfer moment occurred in a structured way, within a workshop that would bring together the local finance representatives and the proponent NGO's representatives. This would allow for the overall vision of the project and its technical and procedural implications to ultimately improve within the international management and control system methodology.
The aid worker, who voiced her skepticism on the ability to transfer specific knowledge to the local department, received these recommendations with only partial enthusiasm. This uncertainty was probably the first symptom that would eventually lead to the aid worker's resignation. Given her absence, the knowledge transfer workshop is yet take place. However, this element continues to be a vital component for the second year, and will certainly be an activity for the new project manager. In addition to the strong cooperation between the applicant and the local counterpart, the monitoring mission certainly highlighted a weakness in the verification of the procurement procedures put in place by the counterpart: procurement activities are concentrated at the central office in Juba and not delocalized at the intervention sites. In light of the above, a review of the procedures has been proposed, so that the intervention sites would have more room for action and could reduce the considerable transport cost between the capital and the rest of the country. In fact, via land, the Juba-Maridi transit can take between the 12 and 24 hours, depending on the season. The aid worker was supposed to present a proposal to revise the methodology, and as in the above case, the task will fall upon the next program manager.
2) Second mission: 1-10 March 2015
Objectives of the Mission and activities:
1) Verification of project activities
o Interview and informal contacts with project managers at the central (Head of Program, Training Coordinator) and local level (Dean and tutors)
o Informal interviews with the beneficiaries of the project (students)
o Assess the construction work progress
2) Verification of project goals
o Assessment of progress on training activities (records and exams)
3) Measurement of the participation level and impact
a. Informal interviews with central level institutions (Ministry of Health and Capacity Building for Human Resources for Health) and local authorities
4) Analysis of the project's strengths and weaknesses
a. Targeted meetings with the various stakeholders of the project
1) Third mission: 18 - 30 April 2015
Objectives of the mission and activities:
1) Evaluation of the financial plan:
o Verification of the registry and the first collaboration note with the local representatives of the Department of Finance
o Information of donor procedures, training of local staff within the department of finance and administration
2) Analysis of the project's administrative-financial strengths and weaknesses
a. Study of the expenses registration system
b. Interviews with administrative staff dedicated to the project
Conclusions and recommendations:
The project is consolidated in its ordinary training and development activities. The interviews with the students and tutors (necessary material for the advertising campaign) reveal a good level of participation in achieving the final goal (training and returning to the community of origin). The lessons continue despite the difficult context of the country, that has only partially affected the implementation (which feature a slight delay compared to the work plan). Overall, the project is in line with the forecasts, notwithstanding the general level of complexity in which South Sudan finds itself since December 2013. The main difficulties emerge in the financial and procedural aspects, as amply demonstrated by the technical mission, which took place in parallel to the monitoring mission.