SAVING LIVES
ANNUAL REPORT 2018
PAC-Somalia
CONTACT US : PAC Somalia Head Office Name : Mr. Abdulahi Yusuf Mohamed Tel: +252 616 80 85 19 Email: a.mohamed@physiciansac.org
PAC UK 020 7993 6900 info@physiciansac.org physiciansac.org
Technical Management Team Leader : Name : Dr. Mohamed Abdirahman Salad Tel: +252 618 99 95 93 Email: M.salad@physiciansac.org Home #13, Imam Shafi'i road, Taleex, Hodan District, Mogadishu Somalia
Data in this report are gathered from the health facilities run by PAC and this annual report is prepared by PAC -Somalia Country Office and it will be presented to the Board of trustee of PAC, June -July 2019.
TABLE OF CONTENTS TITLE List of appreviations Note from the country director Governance structure Introduction of PAC activities in Somalia Somalia Humanitarian Context 2018 PAC Intervetions: humanitarian leadership and coordination humanitarian strategy Summary and analysis of achievements Success Story Nutrition Programme Success Story Fistula Report Analysis 2018 Activity report Human Resource Capacity Building Activities Logistics and Supply chain Management Summary results in numbers Financial Outcome Review Challenges for 2018 and beyond Acknowledgements
PAGE 02 05 06 07 08 10 11 12 13 18 19 21 23 27 27 28 30 31 34 35
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LIST OF APPREVIATIONS
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ABBREVIATION
FULL MEANING
ARI ART BCG CEmONC EPI EPHS HIV HMIS MoH MCHN OPD OTP PAC PCA PENTA PLW PMTCT RVF TSFP UNICEF UNFPA VVF WFP SC
Acute Respiratory Infection Antiretroviral therapy Bacille Calmette Guerin Comprehensive Emergency and Neonatal Care Expanded Programme on Immunization Essential Package of Health Services Human Immunodeficiency Virus Health management Information System Ministry of Health Maternal and Child Health and Nutrition Out Patient Department Outpatient Therapeutic Programme Physicians Across Continents Programme Cooperation Agreement Pentavalent vaccine Pregnant and Lactating Women Prevention of mother-to-child transmission Rectovaginal fistulas Targeted Supplementary Feeding programme United Nations International Children›s Fund The United Nations Population Fund Vesico-vaginal fistula World Food Programme Stabilisation Centre
OUR VISION : To improve the quality of life for people suffering from Poor Health provisions
OUR MISSION : To deliver appropriate medical interventions to those in need
OUR VALUES : PAC’s values are inspired by “ whoever saves a life, it is as if he has saved all humanity”.
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ABOUT PHYSICIANS ACROSS CONTINENTS (PAC) Physicians across Continents (PAC) is an international medical charity organization rendering quality health care services to patients and people afflicted with disasters and crisis regardless of their race, religion or country. A group of physicians, pharmacists, nurses, administrators and pressmen working in the field of health established ‘Physicians Across Continents (PAC)” at the beginning of 2003. PAC’s work is focused on both immediate humanitarian assistance as well as long term strengthening of local health systems through training and development of local medical staff. PAC’s work directly contributes to Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all at all ages. This is delivered by our 4 objectives: • Humanitarian Medical Relief • Teaching and training to create and empower local expertise • Establishment of cadres and specialist medical needs • Treatment and control of epidemics
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MESSAGE FROM THE COUNTRY DIRECTOR I’m proud to present PAC’s 2018 Annual Report, which highlights the extraordinary work of our staff and the amazing resilience of the people we assist. At our core, PAC adheres to three overarching principles: to provide direct high-quality medical care and humanitarian assistance to people in need; to work in direct partnership with local health authorities; and to conduct operational and health research that brings innovation to the field of humanitarian action.
our staff and partners registered 226,999 consultations, treated 45,000 U5 children 4,117 for severe malnutrition. We also vaccinated 20,664 children against preventable diseases and trained more than 16,582 mothers to screen their children for malnutrition, and conducted 213 surgical interventions including 125 Fistula surgeries.
vaccination coverage.
In 2018 alone, we trained nearly 80 local health care workers in BEmONC and CEmONC services in order to build their capacity and prepare them to continue the service delivery. We also constructed new facilities in Daynile General Hospital comprising of a maternity ward and a national fistula Centre to For PAC, 2018 was largely strengthen the capacity of the an opportunity to expand its hospital to serve more patients. operation to both Somaliland PAC is only able to assist and Puntland, and much of our people because of the generous work was focused on providing support of our donors – and medical care to people displaced we are deeply grateful for by conflicts and famine/drought your support. We recognize there, particularly to children. that you place great trust Low vaccination coverage, high in us to use every dollar prevalence of diarrheal diseases wisely – and we do. Nearly 95% and acute malnutrition led to of our income is used directly very high child mortality all on program activities. over Somalia. In South Central Somalia, PAC treated nearly Thank you. To highlight just a few examples 4,000 children for severe acute Abdullahi Yusuf Mohamed of PAC’s impact during 2018: malnutrition and expanded the
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GOVERNANCE STRUCTURE The Country Director is based in Mogadishu office, with frequent travels to the project field offices in cities in both Somalia and Kenya. The CD reports directly to the PAC HQ in London.
COUNTRY DIRECTOR
AREA COORDINATOR
FINANCIAL CONTROLLER
OPERATIONS MANAGER
HEALTH AND NUTRITION PROGRAMME COORDINATOR
FINANCE MANAGER
ADMIN AND HR MANAGER
LOGISTIC MANAGER
ACCOUNT EXECUTIVE
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HEALTH AND NUTRITION PROGRAMME MANAGER
FINANCE OFFICER
HMIS OFFICER
FIELD HEALTH AND NUTRITION OFFICER IN KISMAAYO
NUTRITION SUPERVISOR
FIELD HEALTH AND NUTRITION IN DAYNILE
INTRODUCTION OF PAC ACTIVITIES IN SOMALIA Physicians across Continents (PAC) has been operating in Somalia, since 2011, providing primary and secondary health care services in the biggest mother and child hospital in Somalia, Banadir Hospital, in partnership with Ministry of Health and donor agencies. The overall objective was to improve health and nutrition status, contributing to reduce maternal and mortality rate within the community. PAC is also one of the partners that have been selected to roll out EPHS programme to improve health services coverage and strengthen health system in Daynile district since 2015. PAC is currently delivering CEmONC programmes in two main public hospitals in Somalia (Banadir and Daynile) through partnership with Federal MoH and UNFPA. It is one of the organizations that have been selected by UNICEF to roll out health and nutrition programmes in Lower shabele (specifically Afgoye and Awdhegle district) and Lower Juba (Kismaayo district) and in addition to this PAC is one of the partners that is working with Global fund by running an ART center in Kismaayo hospital, where PAC implemented CEmONC programme in 2015 and 2016. PAC is also the leading organization in the campaign to end Fistula in Somali and has since conducted 6 repair campaigns in the country and treated more than 800 cases of fistula. ď śIn addition to that, PAC implements primary health care in Somaliland, Puntland, South West State, Galmudug State, and Banadir region.
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SOMALIA HUMANITARIAN CONTEXT Somalia remains one of the most complex and long-standing humanitarian crises in the world. 2018 has seen some improvements in the food security outlook, mainly due to the above-average Gu’ rainfall and sustained humanitarian response. However, such gains are fragile, serious protection concerns persist and humanitarian needs in Somalia remain high. Climatic shocks, armed conflict and violence are key drivers of humanitarian needs and human rights violations. One third of the total population, or 4.2 million people, require humanitarian assistance and protection. Along with humanitarian action, substantial investment in resilience-building and development solutions will be critical to ultimately reduce humanitarian needs in Somalia. Over 1.5 million people face acute levels of food insecurity (IPC 3 and above) and require immediate assistance for their survival. The median prevalence of severe acute malnutrition has surpassed the
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emergency threshold of two per cent. 2.6 million internally displaced persons (IDPs), marginalized communities and civilians in conflictaffected areas, living in the most vulnerable circumstances, have limited or no access to quality basic services. An estimated 2 million people are living in hard-to-reach, conflictaffected areas, primarily in the southern and central regions of Somalia. Accessibility of those in need is hindered by the presence of non-state armed actors, active conflict and insecurity, as well as limited infrastructure. This has resulted in the reduction in presence of humanitarian partners as well as difficulty in the delivery of assistance. In 2018, poor environmental conditions, limited access to water and insufficient sanitation facilities worsened by flooding and Cyclone
Sagar added to the overwhelming impact of the 2017 drought; driving increased levels of malnutrition and disease across the country. Access to healthcare continues to worsen due to widespread violence, and the health system remains fragmented, under-resourced and ill-equipped to provide lifesaving and preventative services. Somalia has less than 40 per cent of its target of two health facilities per 10,000 population; and has only 19 per cent of its target skilled health workforce. Maternity services are lacking in 74 per cent of IDP settlements. In particular, displaced and marginalized groups face barriers to healthcare and higher exposure to disease.
With over 1.5 million people extremely food insecure, high rates of malnutrition are alarming; leading to worse outcomes from diarrheal diseases, measles, and malaria. ď śThe affected population has the right to dignified and equitable health care on a nondiscriminatory basis that adheres to minimum standards of quality. Needs are especially high amongst IDPs, in areas controlled by non-state armed actors, and amongst underserved rural areas. The sustained availability of financial and human resources, essential drugs and medical supplies, and improved skills of health providers is required to improve outcomes. Emergency and essential services must be
tied to secondary and specialized referral services. Life-saving care for traumatic injury requires scaling-up transportation, stabilization, surgical and rehabilitative care. Public health authorities must be supported to strengthen surveillance to assess risk and target disease control efforts. Conditions necessitate that supplemental vaccination efforts continue, with sustainable improvements to routine vaccination. Independent monitoring and feedback mechanisms must be put in place to identify deterrents to health care. ď śMalnutrition remains a pervasive humanitarian concern, with overall median levels of Global Acute Malnutrition (GAM) at 14 per cent, while many parts of Somalia remain above the emergency threshold of 15 per cent46. Four consecutive seasons of drought during 2016 and 2017 resulted in widespread food insecurity, deepening health, nutritional and water issues that were exacerbated by large-scale displacement. ď śOverall 1.5 million people will require emergency nutrition support and treatment of acute malnutrition, including those in need of preventive
and therapeutic nutrition servicesNutrition cluster 2018. The nutrition situation is at sustained serious levels despite improved food security, reduced disease outbreaks and sustained humanitarian intervention. As a result, around 954,000 children are expected to be acutely malnourished, including 173,600 who are expected to be severely malnourished-FSNU 2018. Given the complex nature of causality, the heavy burden of malnutrition, and the high susceptibility mortality, it is paramount to put collective effort into multi-sectoral and integrated prevention and treatment interventions. Therefore, sustainable solutions require coordination and integration with health, agriculture and social protection among others. It is imperative to protect households and build resilience to minor shocks, and to alleviate economic hardship by preserving vital assets. IDP populations face considerable challenges where high pervasiveness of women headed households are chronically combating high levels of acute malnutrition. Individuals or households may suffer restrictive access to nutrition services due to age, gender, social discrimination, or due to a specific vulnerability such as disability.
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2018 PAC INTERVETIONS: More than 45,000 children aged under-5 were screened since January 2018 for acute malnutrition, with treatment of life-threatening Severe Acute Malnutrition (SAM) provided to over 4,000 children.
In Emergency response, PAC Somalia reached 226,999 needed beneficiaries in Somalia including 122,752 U5, 62,093 Women and 42,154 Men. PAC supported both IDPs and Host communities in their scope of work in Somaliland, Puntland, Jubaland, SWS and Banadir, most of the beneficiaries was most vulnerable group of women and children and this is increased access to quality off essential health, nutrition and hygiene services-FP, ANC, PNC, SBA and referral of high risk cases- for crises affected and host populations aimed at reducing avoidable maternal and child morbidity and mortality
Under the goal 1 of ART center in Kismayo for contribution to reduction rate of new infections and under goal 2 for reduction of HIV related morbidity and mortality for Somali women, men and children by 2020 PAC Somalia In Kismayo ART reached currently 43 clients are taking regiments and 14 of them are female while 28 are male and the remained is a child which is new to the program while there are other two kids but they reached the adult regiments according to their weight, we have 7 loss of follow up and two deaths during the reporting period while we have one transfer out. PAC under Jubaland MoH and local partners in prevention HIV infections specially among key populations Vulnerable women and men and health workers who are intact of human fluids through combination of HIV prevention interventions as well as PAC ensured all the means of increasing utilization and access of quality integrated prevention, treatment, care and support of Jubaland community.
PAC strengthened emergency preparedness and response capacity in their scope of work at all levels in order to mitigate and response to communicable diseases outbreak in an efficient, coordinated, and timely manner. In response I n 2018, PAC conducted 6th fistula campaign and a to an increase in cases of Acute Watery Diarrhea (AWD)/ number of 129 (94 VVF, 4 RVF, 29 UVF and 2 others) fistula cholera in Banadir region, PAC supported the activation of survivors benefited from the campaign. the Banadir Hospital cholera treatment center, providing supplies for treatment of up to 2,000 cases of AWD/cholera.
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HUMANITARIAN LEADERSHIP AND COORDINATION PAC is an active member of the country coordination bodies including health and Nutrition clusters and participates in the Inter-Cluster Working Group, which leads strategic and cross-sectoral coordination of humanitarian programmes.
working groups like RH working group lead by MoH with the support of UNFPA and Health working group lead by NGO consortium with the support of WVI.
activities in Somalia.
PAC is an active member of National Fistula steering committee and MDSR task force to contribute to the national Fistula eradication campaign lead by PAC closely coordinates with the MoH with the support of UNFPA. federal member states and Somaliland P AC is an active member of sub-cluster in humanitarian related projects and
One of the fistula advocacy and coordination sessions
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HUMANITARIAN STRATEGY PAC’s ongoing humanitarian action focuses on an integrated, multisectoral response to residual drought impact, displacement, conflict, disease outbreaks and seasonal floods. In line with the 2018 Somalia HRP, as well as the HNO. PAC’s priorities are to provide inclusive, life-saving services to address critical malnutrition and excess mortality, effectively respond to mounting protection threats, as well as
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support resilience building and early recovery for the most vulnerable in a population. UNICEF, UNFPA, KSRelief are supporting this in 2018. PAC is maintaining critical service provision in the highest need areas, procuring life-saving core pipeline supplies and continually looking to expand partnerships and coverage in hard-to-access areas and among socially marginalized populations like IDPs in Banadir, affected host
communities in Somaliland and both IDPs and host communities in Puntland specially in Garowe and Bosaso. Life-saving programme integration prioritizes nutrition, health and WASH services, complemented with protection mainstreaming in health and Nutrition interventions, as well as, adopting a gender-responsive and social inclusion-based approach to targeting.
SUMMARY AND ANALYSIS OF ACHIEVEMENTS Health Programme 1. CEmONC: PAC implemented born care while PAC referred eradication campaign in Somalia with the support of UNFPA two complicated and difficult cases while PAC came with initiative of CEmONC centers in Banadir to district hospitals where moving to fistula routine repairs in hospital and Daynile general comprehensive services are newly established fistula centers hospital with core activities of free available. in Somalia with the support of service delivery for both mothers 3. PHC: PAC implemented primary federal MoH of Somalia and and the new born including free UNFPA. health care projects in Somalia consultations for pregnant and under the framework of EPHS 5. HIV project: PAC implemented lactating women, skilled and safe with different donors including ART center in Kismayo district deliveries, and free obstetric and KSRelief and UNICEF while these with the support of UNICEF gynecological operations. projects were part of reduction of under Global fund initiative for 2. BEmONC: PAC implemented 11 maternal and child morbidity and prevention and treatment of HIV basic emergency obstetric care mortality rates. and TB in Somalia. This project in Somalia funded by KSRelief, 4. Fistula repair campaign: PAC is part of overall strengthen of UNICEF and UNFPA in Banadir, health system under EPH frame conducted 6th fistula campaign Lowe Shabelle, Nugal, Bari, and work in Somalia. in 2018 as part of broad fistula MarodiJex for mothers and new
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Daynile General Hospital OPD
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# of crisis affected people with adequate access to PHC services provided with emergency life-saving health service
Figure 1: shows emergency interventions in Somalia specially PAC were increased and most of beneficiaries from most vulnerable group- women and children. # children under 1 year received Penta3 vaccine
Figure 2: shows that routine immunization is increased from July up to Oct and dropped down after that because of the RI scale up in Daynile district where outreach activities is increased and door to door methodology were used.
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# of emergency affected pregnant and lactating mothers who have received delivery services by skilled birth attendance
Figure 3: shows that at the start of 2018 deliveries were very small in number but after two new projects started in April 2018 it has come to the peak and since that it is semi stagnant. # of PLW reached through ANC & PNC Consultations
Figure 4: this figure shows continues increase of the ANC consultations during 2018 and especially from April up to December 2018 because of two new projects that were active in that specific period.
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# of people who were tested for HIV and received their results during 2018
Figure 5: this figure shows that’s the voluntary counselling in Kismayo ART center clients were fluctuating in the course of 2018 and most of the clients were referred from the both public and private health facilities in Kismayo district. # of people living with HIV currently receiving ART.
Figure 6: shows that at the beginning of the 2018 the defaulter rate were high and after peers efforts most of the clients came back to the ART program as well as new cases were admitted from June up to Nov 2018.
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SUCCESS STORY Tackling Cholera: A lot of work has been done in terms of tackling the acute watery diarrhea especially providing appropriate case management in order to reduce mortality. Also, an extensive behavioral change communication programme was conducted to foster improved personal hygiene and safe water practices in the community. These programs included advice on home oral rehydration Therapy and on seeking treatment at designated facilities before serious complications arise Meet Malyun Adan Sid-Ali Malyun Ali, 35, is a mother of 6 and a caregiver to her elderly parents.
AFTER
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After being displaced from Godey, a village in Beledweyne town, after a period of floods in the area, she lost all her family assets including her farm plantation and stored crops. Malyun had to seek an alternative shelter, moved her family to weydow IDP camp in Mogadishu, and left her husband in the village to restart farming after the flood season.
On visiting the CTC at Banadir Hospital, her kid was found to be dehydrated and immediately given some IV solutions and ORS and was registered as a beneficiary of the “Hygiene kit” which she could not afford with her meagre income. With the hygiene kit and the health promotions messages in place, her health and her kids’ health has improved and their drinking water Malyun does odd jobs washing clothes looks better and cleaner than before for people and hawking bread in the “I am grateful for the support the team area to cater for her family. Some of has provided me in the provision of our outreach team checked her and hygiene kit items aside from medical her kids and advised her on home and nutritional treatment support and oral rehydration Therapy and to I hope they continue providing them”, immediately seek treatment at Banadir says Malyun. Hospital for further checkup.
BEFOR
NUTRITION PROGRAMME PAC implemented in 2018 a very • Mother-led MUAC approaches (multiple micronutrients and Iron comprehensive and integrated were used to identify and diagnose folate) and children 6-59 months emergency Nutrition intervention malnutrition by mothers. Mothers with Vitamin A supplements. for both vulnerable host and IDPs were used MUAC tapes to measure • The nutrition intervention communities in Banadir and lower the Mid-Upper Arm Circumference promoted home based fortification Juba regions. These interventions (MUAC). Mother led MUAC to enrich the diets of young included A full package of community training were conducted to children 6-23 months through and facility based nutrition services support mother’s to screen, detect the distribution of micronutrient from edema and self-referral of their Powders. children to nutrition sites. • Identification, referral and • As part of reduction child treatment of children suffering • Prevention services were included morbidity and mortality rates from severe acute malnutrition deworming for children 12-59 PAC concentrated to give routine through community, facility based months and pregnant women immunization as integral part to approaches and OTP Mobile in the 2nd and 3rd trimester, OTP and to reduce morbidities teams. counselling and promotion on and mortalities related to vaccine infant and young child feeding. • Complicated cases of SAM were preventable diseases. referred to SC and MAM to TSFP • Community mobilization and centers in both Banadir and Lower screening as well as micronutrient Juba regions. supplementation for PLW
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# of children 6-59 months admitted for Severe acute malnutrition
Figure 5: this figure shows SAM cases admitted in the course of 2018 and April admissions were remarkable because of coincidence with AWD in CSS.
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SUCCESS STORY Pictures tells a thousand words. This is a story of a mother, Jamilo Omar, who lives in a camp of internally displaced people in Burbawaqo in Daynile district of Mogadishu. Her two and half year old boy, Abdiwahab Hussein, got sick but she didn’t recognize the sickness of her child for a while. One of PAC community mobilize visited her at her Bush not far from the HF. When the mother noticed there was something different about her child she followed her instincts and brought him to the hospital. He was admitted for 5 days due to a severe pneumonia without appetite and also malnourished being underweight. The child was transferred to the SC for Pneumonia and Malnutrition treatment with an anthropometric measurement was MUAC=8.5 WEIGHT=4.4 HEIGHT=79.7. Within seven days, Abdiwahab recovered from the Pneumonia and was transferred to the OTP program. His mother, Jamilo, used to bring him back to the hospital
for his weekly follow up and get his share of RUTF. Initially, Jamila had lost hope, sadness covered her face and the pain in her eyes could never be described. But after every visit the hope was restored little by little. Three months later, Abdiwahab was discharged from the OTP and his mother was very happy. The pictures will tell a better story. giving a mother like her and many more a chance to be happy and a better life with their children is more than enough reason to wake up in the morning and putting a smile on a mother and child who forgot that life can be beautiful.
BEFORE
AFTER
Current MUAC =12.2 WEIGHT=8.2
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FISTULA CAMPAIGN ACHIEVEMENTS Physicians Across Continents (PAC), as the leading organization championing for quality maternal care, continues to reach some of the most isolated women that are suffering from fistula condition.. Furthermore, PAC has brought expert fistula surgeons since 2014 where 6 fistula campaigns were conducted since then.
and 2 others) with fistula condition midwives and 15 nurses participated in benefited from the campaign. the operations, case management and b.Social Reintegration and screening of the patients as direct shift of skills to local medical staff, who were Sensitization Activities: selected from different hospitals and PAC has taken several social activities educational institutions in Mogadishu, such as counseling, providing free with the support of the Federal MoH, transport, free meals during the stay and giving a pair of clothes. Surgical repair alone, while going a long way In the 6th obstetric fistula surgical in helping women reclaim a normal campaign, 129 mothers received free lifestyle, is probably not enough to surgical repairs. 70% of the mothers had address the impacts of living in fistula. vesico-vaginal Fistula (VVF) conditions where more than 50% of them who have As part of sensitization activities, PAC undergone extensive surgeries where has undertaken efforts to educate and urethral reconstruction were conducted build the capacity of fistula survivors in addition to the fistula repair. 58% of themselves, to enable them to get the patients who received these repairs income generation sources after the were from Mogadishu, this shows that treatment. Somali Medical Association (SMA) and access is better in the capital compared c.Capacity Building Activities: Somali Midwifery Association (SOMA). to the other regions. PAC has conducted capacity building PAC has also conducted theoretical a.Treatments: activities during the campaign where 40 Training sessions on how to prevent the 129 patients (94 VVF, 4 RVF, 29 UVF trainees comprising of 10 doctors, 15 fistula, causes, types of fistula etc.
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FISTULA REPORT ANALYSIS 1. Age of Mothers Age Categories
Figure I. Age categories of Fistula patients in Daynile Hospital
60 50
Remarks: As you can see the 19 -29 yrs age category has the highest prevalence of fistula. A good number is also seen in the next decade. Women of early marriage who are less 18 yrs are also seen to be having a the condition
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40
38
30 20 10
16
12
5 7
0 >18
19-29
30-39
40-49
>60
50-59
2. Marital Status of Mother Table 1: Marital Status among patients of Fistula repair in Daynile Hospital, Jan 2019 Remarks: The paradox of this surgical campaigns were 74% of the women with condition were married and not divorced due to the condition. Early reports and the literature shows that the women with this condition were divorced immediately to smelling of urine or/and feaces.
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3. Literacy of Mothers Table 3: Literacy among patients of Fistula repair in Daynile Hospital, Jan 2019 Remarks: All over the world fistula is common in poor women, whom due to this social economic status will be illiterate, while this is a great factor in not seeking health care as demand arises. Mother usually fall in the hand of Traditional Birth Attendants (TBA) who don’t refer complicated cases and eventually result death or fistula. 4. Parity of Mothers Table 4: Parity among patients of Fistula repair in Daynile Hospital, Jan 2019 Remarks: 49% of the parity of mothers were in the category of 1–3 children which shows the trends to be high as a result of earlier pregnancies and childbirth.
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5. Fistula Condition
Fistula Condition
100
Figure 2: Types of condition among patients of Fistula repair in Daynile Hospital, Jan 2019
94
50
29 4
2
0 VVF
RVF
UVF
OTHER
6. Causes of Fistula
Remarks: 70% of the operated cases were Vescio Vaginal Fistula (VVF) and 22% Urethro-vaginal Fistula. UVF demanded urethral reconstruction in addition to the repair. Experts have conducted successful without failure on the reconstruction
Table 6: Cause of Fistula among patients of Fistula repair in Daynile Hospital, Jan 2019 Remarks: Obstetric labour is the major cause of the Obstetric fistulas ‘and as noted in this analysis among patient 97% of the patients who were provided the service reported that the fistula followed a long and obstructed labor
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7. Regional States Table 7: Regional States of the patients of Fistula repair in Daynile Hospital, Jan 2019
Remarks: 58% of the mother who received the services lived in the capital, as this doesn’t mean the condition is more common in the capital compared to the other regions. Access to the facility and information is said to eases’ mother in capital to reach the health facility and that treatment is available.
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HUMAN RESOURCE PAC considers its staff the most valuable asset it has and therefore it expects the highest standards of ethics and performance from them and those who work with us. In this regard, PAC has established policies to govern how staff should conduct themselves and work in appropriate working environment.
of independence, integrity, impartiality and accountability that all must adhere to. It also clearly states principles/policies regarding Sexual harassment, conflict of interest, abuse of power and the work environment.
In addition, PAC reviews the performance of its staff on annual All staff are trained on the Code basis where their performance are of Conduct which stipulates evaluated and based on that their the values and principles promotions are done.
CAPACITY BUILDING ACTIVITIES In 2018, building the capacity of the staff was one of enormous achievement that PAC have made. The targeted staff were mostly the program staff who received well equipped training to improve their performance at the field, as PAC is principally aiming to strengthen the capabilities of the community. The staff who were successfully trained consisted of 69% female and 31% male, this strengthened the quality
of the work they perform in their respective positions. The specific trainings included the following; • BEmONC & CEmONC • Health and Hygiene promotion • Hygiene Promotion campaign/ Outreach • IMAM training • HMIS trainings
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LOGISTICS AND SUPPLY CHAIN MANAGEMENT PAC has developed different formats of documentations so as to ensure a high level of internal controls necessary for effective and efficient utilization of the available resources to achieve the stipulated objectives.. During the year, the logistic and supply chain management strictly complied with the existing process which was documented by an independent consultant. The Logistics team operated 7 ambulances for our sites including running cost and
maintenance. The primary distribution management goal was to maintain a steady supply of pharmaceuticals and supplies to facilities where they are needed, while ensuring that resources are being used in the most effective way In 2018, PAC have supplied a large quantity of supplies including items that need to be replaced on a routine basis, including: disposables, single use items and also equipment consisting beds, examination tables, sterilisers, microscopes and weighing
Drugs and Equipment Supplied
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scales to its regions it operates in Kismayo, Garowe, Bosaso, Hargeysa, Afgoye and Mogadishu. These supplies included the appropriate supplies, equipment and drugs, in order to meet priority health needs and to avoid wasting limited resources. Making sure that health facilities have adequate supplies, equipment and drugs is also essential to boost the confidence in our health services and health workers.
PAC Main Warehouse
PAC CD handing over 2 ambulances to minister of health in Puntland
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SUMMARY RESULTS IN NUMBERS INDICATOR
BASELINE
TARGET
ACHIEVED
PERCENTAGE %
1.1 # of crisis affected people with adequate access to PHC services provided with emergency life-saving health service
42,631
234,205
281,567
%120
1.2 # children under 1 year received Penta3 vaccine
2,150
5,076
20,664
%407
1.3 # of emergency affected pregnant and lactating mothers who have received delivery services by skilled birth attendance
1,233
4,283
4,187
%98
1.4 # of PLW reached through ANC & PNC Consultations
7,335
16,314
53,874
%330
2.1 # of children 6-59 months admitted for Severe acute malnutrition
1,599
1,782
4,117
%231
2.2 # pregnant and lactating women receiving infant and young child feeding counselling
7,335
16,314
16,582
%102
2.3 # of mothers initiating breastfeeding with one hours after delivery at health facilities
1,233
4,283
4,187
%98
3.1 # of people who were tested for HIV and received their results during 2018
1,318
1,581
1,687
%107
3.2 # of HIV positive pregnant women who received ART during pregnancy
0
1
1
%100
3.3 # of people living with HIV currently receiving ART.
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45
42
%93
3.4 # of people living with HIV in care who are screened for TB in HIV care or treatment settings.
0
45
42
%93
0
100
129
%129
1. Health
2. Nutrition
3. HIV
Fistula 3.4 # of mothers who benefited from the obstetric fistula repair campaigns
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FINANCIAL OUTCOME REVIEW Income In 2018, PAC received a total amount of USD 3,291,102 which a total of 2,788,193 received in cash while a total of 502,909.77 received in kind. The following shows the source of income and the amount for each source. Where Our Income Came From Income Source
US $
%
PAC HQ Office UNICEF UNFPA KSRELEIF WFP UNRISTRICTED FUND Income in kind (donated commodities)
410,182 1,166,563 576,146 624,556 3,945 6,800 502,909.77 1,393,185
12.5% 35.4% 17.5% 19% 0.1% 0.2% 15.3% 100%
2018 INCOME SOURCES
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Changes in the income 2018 comparing to 2017 Changes in the income Income Source
US $2018
US $2017
Rate of Change
PAC HQ Office UNICEF UNFPA KSRELEIF WFP FAHAD ALUWAITAH CENTER UNRISTRICTED FUND
410,182 1,166,563 576,146 624,556 3,945 0.00 6,800 2,788,193
319,100 631,016 0.00 0.00 17,204 200,000 127,300 1,294,620
29% 85% 100% 100% -77% -100% -95% 115%
Due to economic enhancement and signing new projects in 2018, PAC’s income has extremely increased by 115 per cent compared to 2017. This was mainly due to the new agreement with King Selman Humanitarian and relief Centre to intervene providing primary healthcare service in 5 different locations in Somalia as well as refunctioning of CEmONC sites including Banadir and Daynile hospitals.
HOW YOUR MONEY WAS SPENT Expenditures The total expenditures of 2018 were incurred as per below details: Expenditures
US $2018
US $2017
Rate of Change
PAC HQ Office UNICEF UNFPA KSRELEIF WFP FAHAD ALUWAITAH CENTER
298,768 1,002,694 576,146 480,706 3,945 0 2,362,260
461,536 741,613 0 0 17,204 200,000 1,420,353
35% -35% -100% -100% 77% 100% -66%
Total expenditure at US $ 2,362,260, represents a 66 per cent increase from the 2017 level of US $ 1,420,350 As previously outlined this increase is primarily due to the new PHC intervention in the area that PAC was not present like Puntland and Somaliland.
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NOTE ON INCOME AND EXPENDITURES
1 GRANT INCOME 2,018 2,017 USD USD PAC Head quarter 410,182 319,100
UNICEF
1,166,563
UNFPA
576,146
KSRELEIF
WFP
631,016 -
624,556 3,945
17,204
FAHAD ALUWAITAH
-
200,000
Other unrestricted income
6,800
127,300
2
2,788,193
1,294,620
Grant Expenditures
2,018 USD 2.1 Headquarter Expenses
298,768
2.2 UNICEF Projects Expenses
Integrated Emergency Health and Nutrition
539,202
Nutrition Daynile and Kismaayo
419,727
HIV Programme 43,765 2.3 UNFPA Projects Expenses
6th Fistula Campaign
82,521
Banadir CEmONC 394,000 Daynile CEmONC 86,000
Bandiradley BEmONC
13,625
2.4 KSRELEIF Project Expenses
Primary Health Care
480,706
2.5 WFP Programme Expenses MCHN Kismaayo 3,945 Total Expenditures 2,362,260 Fund Balance 425,933
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CHALLENGES FOR 2018 AND BEYOND During the last year, the achievements made have been tempered by some challenges that PAC will strive to overcome in close collaboration with our partners and stakeholders. Some of these challenges require us to undertake targeted technical cooperation and develop and adjust relevant policies and strategies based on the lessons learned. There is a clear gap between humanitarian need and available funding critically needed for the ongoing work to strengthen preparedness and response for health emergencies that is critical for building resilience in health systems and the community. PAC has taken
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steps to minimize this gap to be able deliver appropriate programming to reach more beneficiaries in the to remove access barriers to all, inaccessible areas. particularly populations in situations Within the context of limited of vulnerability, is weak. PAC, with national capacity to spearhead the appropriate funding, will be able sustainable health efforts to address focus on expanding health care to the prevalence of fistula cases in improve access and meet the health the country and ensure effective needs of the population, especially approaches, a critical imperative is those in areas controlled by non-state strengthening the leadership role actors. of the federal health authorities to formulate a national strategic plan. This will enable transformation of health sector governance and improve the effectiveness, efficiency, and equity of the healthcare provision.
Due to the delays of funding and fulfillment of the humanitarian pledges, it was difficult to achieve the workplan activities on time, PAC purposes to increase its budget for contingency activities in order to be Due to the continuing insecurity, able to meet the deadlines highlighted the capacity of health systems to against its annual workplan.
ACKNOWLEDGEMENT In 2018, PAC could not have done its work without the support of our staff, volunteers and donors. Therefore, we thank all of them very much for their greatly appreciated support. We are grateful to our dedicated and passionate staff and volunteers. As a team, they continue to provide professional and accessible healthcare assistance to vulnerable people in
Somalia. We are very glad to have We are also grateful for the strong them as part of our team. partnerships we have with our donors We are sincerely thankful to our i.e. King Salman Humanitarian Aid volunteers and donors and supporters. and Relief Centre, UN agencies We could not assist as many people icluding UNFPA, UNICEF and WFP as we do without their generous and our other donors. It is only support, which plays a vital role in with the invaluable support of these achieving positive outcomes for our organisations that we can continue to provide access to quality healthcare. beneficiaries.
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