1. Community Mobilization in Emergencies Use of Community Action Cycle Model to Improve Maternal and Child Health in South Sudan Michael Odong 1 ; Morris Ama 1 ; Telesphore Kabore 1, Jackline Mumi 1, David 1, Asayehegn Tekeste 2

2. OUTLINE Purpose of the intervention Geographical coverage Description of the intervention Process results Changes in Maternal and Child Health outcomes Innovations Challenges and opportunities

3. Purpose of the Intervention Aimed at improving RMNCH outcomes through improved community capacities

4. WES: 11 Counties,159 Facilities, …HHP and …BHCs CES: 6 Counties, 198 Facilities, …HHPs and …..BHCs Geographical Coverage

5. The Interventions Implementation of a Community Mobilization approach using the Community Action Cycle Provision of Community Based Services through Home Health Promoters

6. Intervention (1): Community Action Cycle (CAC) Organize the Communities for Action Prepare to Mobilize Plan Together Act Together Evaluate Together Prepare to Scale-up* Explore Health issues & set Priorities

7. The Intervention (2): Community Based Services Package Home visits Individual and Group communication Active case findings

8. The Intervention (2):training packages for HHPs

9. Training and Supervision Training of Home Health Promoters Curriculum adopted and approved by MOH It covered 4 modules (child health, maternal health, WASH and communicable diseases) 5 days training, 60% in-class and 40% practical in the community Training done by Gov staff, supported by NGO staffs Job aid (Counseling charts) is provided to HHPs immediately after training Boma Health Committee 2 days orientation of BHC on roles, responsibilities and CAC implementation On-job mentorship on use of CAC tools Supervision Monthly supportive supervision to BHCs by Community officer Monthly supervision of HHPs and quarterly review meeting by BHCs Supervision guided by standard CAC checklist. Quarterly award and recognition, integrating with health-days

10. Process Results (1) 218 Boma Health Committees (BHC) reactivated 178 BHC developed action plans that are under implementation to address RMNCH issues with regular documentation/reporting BHC in 92 facilities BHC work closely with facility management to ensure rightful amount of drugs are received, documented and properly stored. Overall increased individual and community collective decision-making on addressing health issues with concrete actions registered in 72 facilities: – Latrines constructions, – Waste pits, – Compound cleaning – Regular monthly community awareness meetings – Waiting rooms constructed – Construction of Health Workers houses

11. Process Results (2), Nzara County 69 Home Health Promoters (HHPs) trained and equipped. 16 BHCs reactivated 15 health facilities Results: – 15 out of 16 BHCs were meeting monthly. – Updated work plan and documenting progress in implementation. – All 16 facilities had latrines, wastes pits and ensure clean compound all time. – Monthly defaulter rates for EPI dropped from over 40% to less than 8%. – Over 5850 of home visits conducted within five quarter with each HHPs making average of 10 visits a month. – 4789 people cumulatively reached through group or individual education in five quarters ( see graph)

12. Process Results (3)

13. Outcomes (1)

14. Innovations by Boma Health Committee in Nzara 1.Fixed meeting date: this addresses the challenges of mobilizing BHC members for meetings. 2.Open attendance lists: a chart with lists of all the members developed and placed on the wall of their meeting room at the facility. Members register their attendance by self ticking against their name.

15. Challenges Not enough supportive supervisions were conducted, Lack of funding to support community actions High turn over of staff Difficulties maintaining contacts with mobile communities Disruptions in implementation – Security and safety – Lack of local NGOs capacity

16. Challenges (2) Less priority in terms of funding are always given to community activities than facilities activities Coordination challenges as national policy to guide the work of community health workers still under development Weak health systems (lack of HRH and supplies,) to manage referral from the community Routine measurement and data use for community health services are poorly developed at national level. Hence data collected at program level does not reach to national ministry of health