.The Nehemiah Field clinic is  the sole property of Operation Nehemiah Mission International (ONMI) as a church, running under its direct administration and it is a privately own venture serving God's people in New Sudan. The clinic is operating as health center III as we hope to step it to health center IV (hospital) in the nearest future depending on how God blesses the project.


 Objectives of the Nehemiah clinic:
To improve the health status of the returnees and also host communities by providing basic health care services, primary health education, water and to help and improve the basic health services of the southern Sudan (Magwi county), building long term capacity through equipment of the hospital, training and support.
Provide Clean and Safe Water through Improved Community Participation To provide general health and sanitation education parallel to the treatment of those requiring medical attention

To expand and consolidate provision of a comprehensive package of basic services and
disease control, of acceptable quality, particularly to the population
Aiming at reducing mortality and morbidity
To strengthen emergency preparedness, response and mitigation
To build, strengthen and sustain the institutional and human resources capacities of the health actor.


Activities planned to reach this objective:

Recruitment and train health staff or provide refresher training for staff basing on academic merit better health service delivery.
Provide basic health care services- i.e. preventive (routine vaccinations and health education), promotive, curative and rehabilitative.
Procure and avail minimum initial service packages for safe child deliveries for the pregnant women enroute, prove family planning services.
Conduct health education and diseases awareness to the affected population to create demand for health services.
Provide referral services for the severe and critical medical cases to nearest medical facility (including provision of ambulance services for the transportation of the ill).

Nehemiah Medical Mission (Health and Water/Sanitation). In March 2008, the Nehemiah Health Center building in (Beth Israel) Borongole has been completed. The container with 6 tons of medicine (worth $10 million donated by International Children Fund), had finally arrived and was being unloaded. We reflected that it has been 5 years since our Operation Nehemiah team first hacked and burned its way through thick brush to the present site of the clinic and the mission house.


Statement of problem and outstanding need
Since 1983 when the just ended 22-year war broke out, the county has suffered repeated devastating attacks from the Government of Sudan backed militias. The aim of these attacks was to destroy livelihood assets, steal livestock, kill people, abduct women and children and force them into slavery and general looting. This situation resulted into people migrating to either the North Sudan, or across within region in South Sudan. Other hundreds of thousands went up to Kenya and Uganda where they lived as refugees. This massive displacement of people went on until 2001 when the recent ended Sudan peace talks began in Kenya.
With reduced activities of LRA within the areas of eastern Equatoria state, there has been massive repatriation of people of eastern Equatoria in Magwi County comprising of the following tribes, Madi, Lolubo, Acholi, and Lotungo by the UNHCR.

According to UNHCR, it has so far repatriated about 24,000 family heads within the county of Magwi. The daily growth in number of the returnees is faced by poor human and animal waste disposal, poor water sources, lack of fund to acquire mosquito nets and high degree of ignorance. Potable water is scarce with women and children spending many hours in the day fetching and carrying water from distant sources. This has had a negative impact on children�s education. It has also affected agricultural production and the welfare of livestock. Sanitation facilities are non-existent in many of these villages and there is little understanding of the health risks.

Justification of Nehemiah Field Clinic  
  Proper human waste disposal is an issue that needs to be addressed if the spread of diseases is to be prevented. There is need therefore to address the issue of human waste disposal by providing pit latrines both at urban and village setting in the province
Protecting the existing water sources by fencing, keeping the surrounding clean and involving community members to actively participate in protecting the water surrounding.
Providing more new water sources in areas where it did not exist and community education on dangers associated with use of water sources contaminated with human and animal faecal matter.
Mosquito nets will be given to pregnant mothers and children who are more vulnerable to malaria as a preventive measure for malaria infection

Broad objective
The overall objective of the project is to contribute to improve health status of the population in Magwi County. by constructing latrines, protecting existing water sources, creating more water sources in areas where it did not exist, community mobilization and giving mosquito nets to pregnant mothers and children who more venerable to malaria.
To improved health status of the targeted areas of Magwi county by promoting use of proper human waste disposal methods and proper hygienic practices.

Specific objectives
Specific objective 1.0 -
To mobilize and sensitize the community
Activities
1. Organize meetings with the community and sensitizing them on the use of safe water, sleeping under mosquito net and importance of proper human stool disposal

Specific objective 2.0 - To construct 1000 pit latrines in Magwi County
Activities
1. Identification of project team
2. Procurement and delivery of project materials
3. Construction of the pit latrines

Specific objective 3.0 - constructing fence around the existing water sources and establishment of new water sources (boreholes)
Activities
1. Identification of the workers/constructor
2. Organizing hygiene promotion meetings
3. Procurement and delivery of project materials
4. Fencing the surrounding of the domestic water sources
5. Contracting water drilling team to drill new boreholes in areas which lack water source.

Specific objective 4.0 -giving out treated mosquito nets
Activity
1. Identification of the distribution team
2. Organizing community sensitization meeting on the importance and the use of insect treated nets
3. Distribution of the nets
1. Implementation strategy
The project intends to promote proper hygienic practices among the targeted beneficiaries in Magwi County. The project objectives will be achieved through participation of project staffs and local stakeholders in order to demonstrate the project ownership that will enhance sustainability. ONMI and the local civil authority will facilitate the community to form groups to promote health, hygiene and sanitation throughout the county. The following will be the operational components of the project:

4.1 Logistics arrangement
ONMI will identify and procure the latrines construction materials. The construction materials required will be sourced from Nimule, Gulu or Adjumani and then transported to ONMI compound in Borongole and then later moved to the latrines sites. Locally hired vehicle will be used to transport the required building materials to the identified sites for the latrines. This will be assured by the project staffs in the project area. The ONMI collaborating partner NGOs in project area will provide vehicle for local transport. ONMI will offer fuel from the project funds to fuel vehicles used for the transportation of the materials.
4.2 Identification of project Team
The ONMI Programmed management is functional in the project area under leadership of Project Coordinator with the assistance of a Project officer. The project will employ six (6) experienced masons to implement the construction of pit-latrines. They will be assisted by fourteen (14) experienced construction casual workers. The project team will receive administrative and logistical support from the Chief Administrator, the Finance officer and the office assistant based in ONMI office at Borongole at Pageri Payam
4.3 Community Sensitization and awareness
The project implementation team will carry out sensitizations and mobilization meetings in the whole of Magwi County. The purpose of these meetings is to enlighten the community of the importance of a healthy society, preventive measures in malaria control and the importance of proper waste disposal methods. These meetings will also ensure that the project is community-owned right from the start. The community will be encouraged to take this activity as a model and continue to do it anywhere else other than Magwi County.
4.4 Construction of latrines
The project intends to construct a total of 100 pit latrines in the following areas Nimule (40), Borongole (10), Kerepi, (30) Mutala (5) and Pageri (15). During the sensitization meetings the community will have a chance to decide on the exact location of the latrines. The project will choose the latrine site by considering the distance from the groundwater points at least 30m away and over 45 meters away from the dwellings. The digging of one pit will be 1mx 1.5m x 6.5 m deep. It is planned to use slabs for the latrine floor. The foundation will be built on the upper part of the pit to support it. The slab will be cast and placed over the pit. The slab will be having a second hole behind the defecation hole with diameter of about 150mm to fix the ventilation pipe. The wall will be made with bricks using cement, concrete and the roofing will be done by iron-sheet. A drainage channel will be made around the latrine to prevent erosion of the pit walls
4.5 Training of Community Hygiene promoters
After completion of the latrines construction, the ONMI will identify groups from the community that will ensure continued promotion of sanitation/health and hygiene practices. Each group will be charged with the responsibility of managing and maintaining the pit latrines. To ensure gender sensitivity each group will be made of women and 2 men. The project will provide them with 3 days training on sanitation/health and hygiene promotion. This training will equip them with the skills they require when performing their duties of hygiene promotion within the community. The local civil authority will undertake care for them in order to manage and maintain the constructed latrines and encourage local population to dig their own pit latrine where necessary

Monitoring
An effective monitoring framework will be established in order for the project to gauge the impact it having and learn from its effectiveness. The monitoring process is expected to generate reports detailing progress on each areas of the activity as measured against planned objectives/targets.
The Project Coordinator will keep reporting to the Chief Administrator on the progress of the project on a weekly basis. His reports will cover the progress of the project activities based on the time frame. This will demonstrate the movement of the team in the ground with completed, on going and planned activities.
ONMI Chief Administrator will prepare the final report, to be submitted to donors, at the end of the project. The reports will include details of tasks that were planned for, accomplishments realized during the implementation of the project.
Financial monitoring will be undertaken by the accountant and will aim at measuring the provision and delivery of services, inputs and outputs as per the project design. The key elements of this category are work schedules and budgets for each project activity and a comprehensive financial and management system that summarizes actual results into pre-determined indicators that highlight performance achieved against targets.

Health status of the returnees and host communities is improved

Process for developing the health center

This will be through an intensive and interactive process that will involve all stakeholders in operation Nehemiah health development. There will be a review which includes examination of annual health sector program performance report, data from health management information system, various monitoring and supervision.

Development goal

The overall development goal will remain the attainment of a good standard of health by all people in Magwi County in order to promote a healthy and improved life. The improved human development will contribute to increased socioeconomic growth and poverty eradication.

CONCEPT FRAME WORK FOR HEALTH SECTOR STRATEGIC PLAN II

Program objective (1) Program objective (2) Program objective (3)
A health care delivery system that is effective, equitable and responsive To strengthen the integrated support system An evidence-based policy, program ,planning an development in place
? Human resource for health
health policy and planning

? Prepare a monthly laboratory record and
Account to laboratory technician

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