Rieayat Umahatina – Caring for our mothers
South Sudan has some of the worst health indicators globally; a symptom of a chronically over-stretched and under-funded primary health system.
Amref is partnering to improve access to quality maternal and newborn health services, reduce preventable maternal and newborn deaths, and strengthen health outcomes for underserved communities in Greater Tonj, South Sudan.
In South Sudan
Amref’s work in South Sudan
In Greater Tonj, Warrap State, over 600,000 people are in urgent need of health services, including 61,804 women of reproductive age. To address this, Amref worked as a lead implementing partner for the Government of South Sudan between 2012 and June 2024 on a health system strengthening programme. This supported the delivery of essential primary health care (PHC), secondary health care, and referral health services, as well as improving health infrastructure development and supply chain management of essential medical commodities.
Maternal and Child Health
Amref rehabilitated 14 health facilities and trained 940 health workers in PHC delivery and 199 midwives on Basic Emergency Obstetric and Newborn Care (BEmONC). We reached 1.5 million people with targeted health messages, leading to a 56% increase in uptake of antenatal care services.
With more reliable, accurate information and care in pregnancy, we are working to ensure safer childbirths and fewer complications for mothers and their babies.
Barriers to Health
Yet, there is still more work to be done. In Greater Tonj, there are only two hospitals providing Comprehensive Emergency Obstetric and Newborn Care services. Both these facilities are severely overburdened—compounded by the strain of intercommunal violence which results in 30-50 emergency gunshot surgeries every month.
Lack of Facilities
When women have complications in pregnancy or childbirth, they are forced to attempt a journey of up to 70km to reach the nearest facility that can treat them.
Tragically, between July and August 2024, women with complications from Greater Tonj were referred to a hospital 105km from their communities. Most women who were forced to make this journey died on the way.
Rieayat Umahatina - Addressing the critical gaps for mothers and babies
There is an urgent need to strengthen emergency obstetric and newborn care, support emergency referrals, strengthen midwifery services at primary and secondary care levels, and increase uptake of services in communities across Greater Tonj.
Amref has partnered with a donor who prefers to remain anonymous on a programme to enhance access to quality emergency maternal and newborn health services, reduce preventable maternal and newborn deaths, and strengthen health outcomes for underserved communities in Greater Tonj. This programme, “Rieayat Umahatina” (Caring for our mothers), will be aligned to the South Sudan Ministry of Health’s Health Systems Transformation Project, to ensure sustainability and integration of quality maternal care services into the health system.
Programme Aims
- Improved access to and uptake of quality maternal and newborn health services for targeted communities, evidenced by a 70% increase in the number of women attending all 4 antenatal care visits and a 30% increase in skilled birth attendance.
- Enhanced capacity and quality of EmONC services in targeted health facilities, evidenced by a 20% reduction in preventable maternal and newborn complications and deaths in two target hospitals.
- Improved sustainability and integration of maternal and newborn health services into the Ministry of Health’s Health Systems Transformation Project, ensuring the long-term impact and institutionalisation of project-supported interventions.
Programme Activities
To increase access to quality maternal and newborn services for the underserved population of Greater Tonj, the programme will:
- Train midwives to conduct skilled deliveries – aiming for 2,000 women receiving skilled deliveries.
- Facilitate ambulance referrals to health facilities for women in labour – aiming to provide this for 300 women in labour.
- Increase service uptake through community awareness – aiming to reach 120,000 community members with community activities and radio talk shows to increase service uptake.
- Increase the number of women attending antenatal care – aiming to achieve 12,000 women attending antenatal care consultations.
- Provide supplies for emergency obstetric care in two hospitals.
To improve the quality of maternal and child health services in health facilities and expand comprehensive emergency obstetric and newborn care, the programme will:
- Train 40 health workers (30 midwives and 10 clinical officers) on basic emergency obstetric care, providing support supervision to ensure this knowledge translates in practice in 10 facilities.
- Deploy a specialist doctor to provide round-the-clock emergency care in two target hospitals – aiming to provide 1,500 women with comprehensive emergency care, and 4,200 men with non-obstetric emergency surgery (gunshot wounds make up the majority of these types of surgeries after intercommunal violence).
- Equip two hospitals with theatre and diagnostic equipment to enable safe surgical procedures, provide delivery kits to 24 facilities, and improve infection prevention and control (IPC) measures in eight facilities.
To advocate for the integration and sustainability of quality maternal and newborn health services into the Health Systems Transformation Plan, the programme will:
- Strengthen government partnerships and institutional frameworks through quarterly advocacy meetings with the Ministry of Health and county health departments
- Produce a policy brief, and joint planning and review sessions with the Ministry of Health so lessons can be incorporated into government plans.
Rieayat Umahatina will be delivered between April 2025 and March 2028.
All Images - (c) Amref Health Africa/Steve Kagia (Banner,2): Midwife Hellen Hadia speaks with a new mother, Mariline Gisma, holding her baby, Miska Hadai, South Sudan. (1,3,4) Mvolo Hospital, Lake State, South Sudan (5) Final-year midwifery student Achan Buong consults Midwife-in-Charge Ruth Tito at Maridi Health Sciences Institute (MHSI), Maridi, South Sudan