Where We Work : Southern Sudan : Health

BRAC takes a multifaceted approach to delivering essential health care in Southern Sudan. We focus on the prevention of malaria, tuberculosis (TB), and HIV/AIDS, the reduction of infant and under-five mortality rates, increasing accessibility to health by taking health care to the doorsteps of the people, and improving utilisation of government and private health facilities.

At the centre of BRAC’s approach are the Community Health Volunteers (CHVs), who are women selected from BRAC’s microfinance groups and trained to provide basic health care. Every day, 120 dedicated CHVs provide door-to-door service to the communities served by eight BRAC branches in the Juba area. In 2010, the health programme will be expanded to three branches in the Bor area in Jonglei state.

CHVs are supported and supervised by Community Health Workers (CHWs), who are staff members responsible for implementing the BRAC health programme at the branch level. Among their duties, they go into the field to help CHVs conduct community Health Forums on such topics as sanitation, hygiene, HIV/AIDS and malaria.

Programme Description

The BRAC Essential Health Care (EHC) programme in Southern Sudan is a scalable model of community health care.

The overall goal of the EHC programme is to improve health conditions and increase access to health services by providing basic health services in communities where BRAC has an established microfinance group. One member of each BRAC borrowing group is designated and trained as a Community Health Volunteer (CHV). CHVs serve the health needs of the entire community, with particular attention to poor women and children.

Programme Objectives

• To increase reproductive health care services by raising awareness, ensuring antenatal care (ANC) and post-natal care (PNC) visits, and facility-based deliveries.
• To reduce the incidence of malaria, especially among pregnant women and children, by enhancing control and prevention.
• To bring positive behavioural change for prevention of HIV/AIDS and ensuring access to HIV/AIDS services through community sensitisation and participation.
• To develop a community based approach to increase and sustain TB case detection and cure rate as per the Millennium Development Goals.
• To improve basic sanitation and hygiene by introducing behavioural change and ensuring access to safe water and sanitary latrines.
• To mobilise women and disseminate information through village meetings and home visits.
• To collaborate with the Government to further facilitate and strengthen the implementation of national tuberculosis, malaria and immunisation programmes.

Programme Components

Reproductive Health Care

One of BRAC's primary concerns is to improve reproductive health care awareness and service utilisation. To fulfill this objective, Community Health Volunteers (CHVs) identify pregnant women during their household visits and inform the Community Health Worker (CHW). The CHWs perform antenatal checkups in the home, raising awareness of pregnancy care and pre-natal danger signs. The CHV keeps a check on whether her clients have taken their Tetanus Toxoid (TT) vaccine. She also raises awareness of the importance of Voluntary Counselling and Testing (VCT) for HIV/AIDS, and Preventing Mother to Child Transmission of HIV (PMTCT).

Malaria Control

During household visits, the CHV identifies suspected cases of malaria and refers the patients to the nearest government health centres. She follows up to determine test results and see if the patient is taking their anti-malarial medication. A relative of the patient is put in charge of supervising the drug intake according to their prescription. The CHV then conducts a follow-up visit to ensure the patient's recovery and to make sure that the patient has not developed further complications. The CHV keeps records of this information in her household visit register.

We are delivering home-based management of malaria as part of the Child Survival Programme of the Ministry of Health, Government of Southern Sudan. This is a project in four counties of Lakes state. Through a community network of our CHVs, treatment for malaria in children up to five years of age is provided through artemisinin-based combination therapy (ACT), relevant information and counselling as well as follow-up and referral for severe cases.

TB Control

CHVs implement a well-tested, community-based approach for increasing and sustaining TB case detection and treatment. During household visits, CHVs ask simple questions related to suspected TB cases (based on symptoms). When a suspected TB victim is identified, the CHV motivates that person to be tested at a nearby government facility. She explains the dangers that TB can pose to the sick person as well as the rest of the family. She then follows up on the patient to determine the test results and advise accordingly.

Family Planning

During regular household visits, the CHV mobilises and motivates women to use modern methods of contraception. She provides clients with birth control pills and condoms. For other temporary and/or permanent methods, couples are referred to government primary and secondary healthcare facilities.

Community Health Initiatives

BRAC takes a multi-pronged approach to community health education. We offer community health forums on issues such as a malaria, TB and HIV prevention, maternal health, family planning and sanitation.

Basic Curative Services

CHVs are trained to diagnose and treat some basic ailments such as diarrhoea, dysentery, common cold, helminthiasis, anaemia, ringworm, scabies, hyperacidity and angular stomatitis. They refer individuals with suspected conditions to local public and private health facilities. CHVs earn a small income by selling over-the-counter medicines to patients.

NEW INITIATIVES

BRAC has been selected to be the survey coordinator and implementer for a malaria prevention programme covering four counties with a population of 355,000 in Lakes State. BRAC is setting up a field office and providing education efforts, training and workers to distribute home-based management of malaria.

Community-based distributors will provide artemisinin-based combination therapy (ACT) medication to children under five while referring other patients to the nearest health facilities. It is part of a campaign coordinated by the international health organisation PSI and funded by the Global Fund The Global Fund to Fight AIDS, Tuberculosis and Malaria.