What are the core problems that Medair intends to address?
Medair’s programme addresses access to health services and safe water, both in selected communities and emergency situations. This is because the war left very few functional social services in Southern Sudan. As an indication, less than 25 percent have access to safe water, with the mortality rate for children under the age of 5 years being almost 25 percent. Only 30-40 percent of the population lives within one day’s walk of a basic health facility, but more than half of the health facilities in Southern Sudan are in the Equatorial region, meaning that Bahr el-Ghazal and particularly Upper Nile are extremely underserved. The humanitarian aid capacity to meet all the needs of this vulnerable population is severely limited. Medair’s programmes are designed to fill the gaps and increase access for the most vulnerable communities to desperately needed health services and clean water, and to provide emergency assistance until the southern Sudanese are able to be self-sufficient.

How does Medair intend to address these problems?

Medair addresses these problems by using a multisectoral approach wherever possible, and is focusing its activities in 2007 in the following sectors:

WatSan in Melut County, Upper Nile

• Provide new or improved safe water sources through borehole provision
• Promote awareness of sound hygiene and the use of good sanitary practices
• Increase the number of skilled local Sudanese to:
• maintain new and existing water points
• educate the community on good sanitary practices and hygiene awareness

Primary health care in Melut County, Upper Nile DDC

• Increase access to, and utilisation of, basic health services through:
• one Primary Health Care Centre (PHCC)
• five Primary Health Care Units (PHCUs)
• Build local capacity of the community-based civil society and local Ministry of Health structures
• Improve health knowledge and practices of trained beneficiaries

Emergency response in health and WatSan sectors in all 10 states

Health

• Investigate and respond to medical emergencies and outbreaks, by involving Internally Displaced Persons (IDPs) and returnees
• Provide high-quality curative, preventative, promotional, and, when necessary, emergency nutritional health care services
• Capacity building for emergency health management:
• improve local management
• implement capacity to manage and run emergency responses at a local level

Water and sanitation

• Carry out rapid needs assessment where information is not available, to establish the feasibility of Emergency Mobile Water Treatment System (EMWTS) installations
• Quickly provide safe drinking water to populations in emergencies
• To promote the use of sanitary latrines during emergencies and good hygiene practice

Mainstreaming capacity building throughout these sectors

Capacity building means equipping members of the local community with new skills to facilitate local ownership and long-term sustainability.

• Integrating beneficiary accountability throughout programming
• Community agreements with all PHC and fixed-site water activities, before activities can begin
• Beneficiary involvement in proposal design

What has the Medair team already achieved ?

Health

PHC (Primary Health Care)
Since the beginning of 2007, Medair has started to establish new primary health care sites in Melut County, which have seen many patients already. In addition, it continues to manage two other PHCUs (situated in Payuer and Thangrial). The location is within the area where many returnees are arriving from Khartoum and other locations from the north. Medair has been planning and discussing with local authorities and the State Ministry of Health in Malakal on the location of the planned PHCC and further PHCUs. In Melut, a temporary PHCC was set up in tents and there are ongoing discussions with the authorities for the establishment of three new PHCUs within three of the underserved payams in the county. There has been health promotion training in both locations, and Village Health Committee training in Payuer. Over 20,000 patients have received treatment so far in all of these locations and the permanent building for the PHCC will be opened in November.

Vaccination has continued in Payuer with children and mothers receiving routine Extended Programmes of Immunisation (EPI). LLITNs (impregnated mosquito nets) are distributed through the EPI program.

Distribution of Non Food Items (NFI) in Melut County

ERT (Emergency Response Team)

2007 has so far proven that Southern Sudan is still very much a prime location for emergency relief, with continuous demands on the Medair Emergency Response Team. 

The beginning of the year saw a meningitis outbreak affecting Southern Sudan, with eventually all ten states reporting cases. In response, Medair participated in three assessments in Renk, Tonj South, and Akon/Lunyak; carried out a case management intervention in Marial Baai, Northern Bahr-el-Ghazal, which included training existing health staff in meningitis case management and carrying out health and hygiene promotion to the affected communities.  In addition, a meningitis vaccination campaign was carried out by the team in Tonj South county, Warrap state.

The first seven months of the year also saw an Acute Watery Diarrhoea (AWD) outbreak affecting many areas of Southern Sudan. In response, Medair participated in nine assessments. The team also assisted the State Ministry of Health (SMoH) in Malakal with the management of a Cholera Treatment Centre, which included training of the health workers in AWD case management and the reporting of cases. In a joint intervention with the Medair WatSan team, a CTC was set up in Akobo, which was handed over to PRDA, and a cholera treatment unit was set up in Thiangrial, Melut county, Upper Nile.

Hygiene promotion was carried out during all these interventions. Medair supported World Relief in Lietnhom in training the health staff on case management and isolation ward procedures, while donating enough supplies to treat at least 50 patients with AWD, and providing training for community members in health and hygiene promotion. 

The period between June and October (rainy season) has seen a marked decrease in disease outbreaks across Southern Sudan. However, Southern Sudan was severely hit by floods, displacing many people from their original homes, leaving them vulnerable to diseases. Medair’s ERT has been involved in eight assessments directly related to the flooding and has been distributing LLITNs.

Renk was one of the first severely hit areas.  Medair responded by sending in a multisectoral team, which was able to meet the direct needs for water and sanitation; train people in health and hygiene promotion; and distribute desperately needed NFIs (Non Food Item kits) and LLITNs. Health workers were trained in surveillance, while health promoters were reaching the community with basic health and hygiene messages to prevent outbreaks.

Medair also supported Tearfund over a period of two months to reach 10 health facilities in the flood affected are of Fashoda. These locations were unreachable by road or air due to the flooding and had to be accessed by river. Medair conducted an assessment of the area, including Oriny and Aburoc, distributed NFIs and LLITNs to displaced people, delivered supplies to the health facilities, and trained health workers in surveillance. 

The number of malaria cases increased rapidly in the months of August and September, with Northern Bahr El Ghazal reported to be the worst affected.  Medair participated in two assessments verifying malaria cases, and supported safe harbour in Nyinbuli with case management, LLITNs, and supplies for their PHCC.  Medair also provided malaria-treatment drugs and LLITNs to AAA in Nyamlell.

August saw a measles outbreak in Khaldak, Northern Jonglei, where Medair conducted a measles vaccination campaign reaching 3,807 children between six months and 15 years old. Health and hygiene promoters were trained and supplies were donated for the PHCC.  Support was given in case management providing treatment for 41 measles patients.

Several assessments on nutrition were done by partner organisations. Melut County showed a high percentage of severely malnourished children. Medair’s ERT is supporting a supplementary feeding programme in the area.

Medair local staff drilling a borehole in Payuer to prevent populations from drinking the dirty Nile water

Water and sanitation