GAP ANALYSIS AND LOGIC MODEL Global Fund, Round 11: Health System Strengthening in South Sudan Abebe Aberra Eli Kern Amira AdamPeter Kithene Ruth DeyaAndrew Mujugira October 21, 2011 GH511: Problems in Global Health

Background Total population 8.26 million  83% in rural areas 1 doctor per 100,000 population  WHO standard: 20 doctors/100,000 Highest maternal mortality rate worldwide  2,054 deaths per 100,000 live births  Only 5% of births attended by medical personnel County Health System PHC Unit County Health Department County Hospital Primary Health Care (PHC) Center

Gap Analysis – Maternal Deaths Current MMR 2054 maternal deaths/100,000 live births Goal MMR of 500 maternal deaths/100,000 live births Estimated maternal deaths/year: Goal maternal deaths/year: Excess maternal deaths/year: 8, ,065 6,418

Gap Analysis - Malaria Estimated malaria-specific mortality rate 100 deaths per 100,000 population Goal of 50 deaths per 100,000 population Estimated deaths/year: Goal deaths/year: Excess deaths/year: 8, ,130 4,130

Gap Analysis – Human Resources for Health 1,005 CurrentGoalGap 1, ,3552, PHC Unit CHWs 1,1443,5442,400 PHC Center Nurses Midwives

InputsActivitiesOutputs Short-Term OutcomesLong-Term OutcomesImpact Existing PHC Units and Centers Engineers and construction workers Recruited human resources for faculty and trainings Building supplies and furniture Antenatal care equipment and supplies Training materials Renovate and equip PHC Units and Centers Renovate teaching institutions Recruit and train nursing and midwifery faculty Train nurses and midwives Increased number of PHC Units and Centers to provide antenatal care Increased number of teaching institutions to train midwives and nurses Increased number of nursing and midwifery faculty Increased number of nurses and midwives Increased number of pregnant women receiving antenatal care from skilled health workers Increased access to health care Decreased maternal mortality rate Collaborating MoH staff Recruited human resources for faculty and trainings Training materials Collaborate MoH to standardize TBA curriculum Recruit and train TBA trainers Train new and existing TBAs with standardized curriculum Standardized TBA curriculum Increased number of TBA trainers Increased number of skilled TBAs Increased number of births attended by skilled TBAs Existing state hospitals Engineers and construction workers Obstetric equipment and kits Collaborating MoH staff Renovate 1 hospital per state to perform C-sections Distribute basic obstetric kits to PHC Units and Centers Collaborate with MoH to establish transport system for blood 1 hospital per state to perform C-sections Increased number of PHC Units and Centers with obstetric kits Increased supply of safe blood products in hospitals and PHC Centers Increased number of births attended by trained medical staff Motorcycle ambulances and maintenance equipment Recruited human resources for trainings Training materials Provide motorcycle ambulances and maintenance equipment Train motorcycle ambulance staff Increased number of motorcycle ambulances and maintenance equipment Increased number of staff with capacity to operate, maintain and repair motorcycle ambulances Increased number of pregnant women who have access to safe transport to health care facilities Collaborating MoH staff Recruited human resources for trainings Training materials Collaborate with MoH to implement essential medicine transport system Collaborate with MoH to standardize curriculum for training in pharmaceutical management Recruit and train pharmaceutical management trainers Train PHC Unit and Center staff in pharmaceutical management Increased supply of essential medicines at PHC Centers and Units Standardized pharmaceutical management curriculum Increased number of pharmaceutical management trainers Increased number of pharmaceutical management staff Increase in steady supply and skilled management and distribution of essential medicines Increased % of women with access to essential medicines Collaborating MoH staff Recruited human resources for trainings Training materials Collaborate with MoH to standardize CHW curriculum Recruit and train CHW trainers Train new and existing CHWs with standardized curriculum Standardized CHW curriculum Increased number of CHW trainers Increased number of skilled CHWs Increased proportion of community primary health care services involving health care workers residing in the same community Increased % of people reporting satisfaction with level of community involvement in primary health care IPT medications Procure medication for IPT of malaria and add to essential medicine package Increased supply of ITP medication at PHC Centers and Units Increased percentage of pregnant women who receive at least 2 doses of ITP for malaria Decreased incidence of malaria among women ITNs ITN retreatment kits Distribution method Distribute ITNs through PHC Units, schools, and religious institutions Distribute ITN retreatment kits through above channels Increased distribution of ITNs Increased distribution of ITN retreatment kits Increased mosquito net ownership Logic Model Inputs ExistingPHC Units and Centers Engineers and constructionworkers Recruited human resources for faculty and trainings Building supplies and furniture Antenatal care equipment andsupplies Training materials Activities Renovateand equip PHC Units andCenters Renovate teaching institutions Recruit and train nursing and midwiferyfaculty Train nurses and midwives Outputs Increasednumber of PHC Units and Centers to provide antenatalcare Increased number of teaching institutions to train midwives and nurses Increased number of nursing and midwifery faculty Increased number of nurses and midwives Short-Term Outcomes Increased number of pregnant women receiving antenatal care from skilled health workers Long-Term Outcomes Increased access to healthcare Impact Decreased maternal mortality rate

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