For review and Comparison Humanitarian Post intervention Third Party Monitoring For Potential Partners UN donations, Unicef protection health Education mission ministry of gender Ministry Country South Sudan East African Community

1. PEHSP review meeting
July – Sept 2019
21 November 2019

2. Findings of Supervision Visits by UNICEF
UNICEF supportive supervisions were mostly
tripartite visits involving UNICEF, IP & CHD
MOH Quantified Supervisory Check list (QSC)
was used

3. INFRASTRUCTURE
- Poor IPC practices (no soap, hygiene supplies, handwashing
stations, disaggregation buckets, filthy HF & filthy latrines)
- Poor waste management practices (open sharp boxes, used
needles on surfaces, burning waste at entrance of HF)
- Minor rehab not started
- No pest control to address bats
- Space not maximized for optimum flow of patients
- No functioning power in spite of solar panel budget
- Often no functional vehicle (in spite of budget for repair) and
communication means in HFs

5. EQUIPMENT
Lack of basic equipment in many HF (stethoscope, thermometer,
blood pressure machine, dressing set, delivery set, delivery bed,
etc)
Lack of laboratory equipment & supplies
Lack of temperature monitoring chart for EPI fridge/vaccines in
stage 3 or 4
Lack of job aids/guidelines (IMNCI/treatment guidelines)

7. HUMAN RESOURCES
- All health workers not all recruited as per signed PD
- Staff not present/ HF closed during visit/no monitoring of staff
attendance & lack of disciplinary measures => ghost workers
- No staff roster => ghost workers
- Health workers occupying positions they don’t quality for, eg
CHW occupying the position of Registered Midwife/no
verification by IP
- No JD or staff not aware of their JD
- Incentives paid to CHD & not to health workers
- No regular staff meeting

8. HIMS
- Lack of registers/HIMS tools
- No submission of monthly HIMS and IDSR reports
- Mistakes/ incomplete data in registers
- Fabricated data!
- Outreach data often not captured
- No targets (EPI/ANC/SBA)
- Lack of knowledge on monitoring EPI indicators (no EPI monitoring
charts/drop out rate, etc) and lack of action (eg no defaulter tracing)
- Transmission of reports delayed
- No coaching on proper HIMS tools
- No feedback from the CHD/IP to the HF on data submitted.
- No data analysis at HF and county level and no plan of action to improve
issues identified

10. PHARMACEUTICALS
- Inadequate space and shelving for drug storage
- Inappropriate drug management & monitoring (no
stock card, no bin card, no system for requisition, no
inventory)
- Late requests for vaccines
-Inadequate disposal of expired drugs
- No inventory or inconsistency between physical
inventory and stock cards

12. SERVICE PROVISION
- Lack of treatment/IMNCI guidelines/job aids in most HFs
- Some HF only offer consultations (no EPI/ANC/SBA/PNC)
- Lack of BEMONC services in many PHCC and CEMONC in hospitals
- GBV/CMR services still not available
- Training on EPI/CMR not rolled out yet
- Major knowledge gap in national protocols eg. IMCI/EPI/ANC /SBA
- Irrational prescription of drugs
- Poor quality of care in OPD, ANC, delivery, FP, PNC observed in most HFs.
- Lack of monthly outreach plan & outreaches not always performed. No
agile mix of different strategies (HF, outreach). EPI mobile teams not started.
- Lack of & Inadequate supportive supervision/ mentoring/coaching. Lack of
action plan per HF

14. UTILISATION OF HEALTH SERVICES
- Overall very low utilization of all services observed in
most HFs supervised & low coverage of services
- No link with & optimization of community
groups/CHWs) to increase uptake of services.
- No defaulter tracing/follow up of U1 for EPI and PW
for ANC
- Lack of community mobilization/awareness

15. A few good practices…..Delivery of services
Adequate service planning:
sketch map of HF catchment area
Delivery of ANC
according to protocol

16. A few good practices….. HR & equipment
Job description for all health staff Job aids

17. A few good practices…..Data management
Data use: EPI monitoring chart Monitoring of ANC & SBA targets

18. A few good practices….. Adequate drug management
& storage
Adequate shelving Use of stock cards

19. - CHD Capacity-building in
supervisory skills?????
- CHD capacity building in data
submission and analysis???
- No monthly coordination
skills
GOVERNANCE….
NOT CAPTURED THROUGH
QSC

20. Actions for a quality
PEHPS!