South Sudan National Action Plan for Health Security (NAPHS) 2020-2024

49 Dr Thomas Akim NPO /WHE/UNS Hub World Health Organization Ujjiga Coordinator so Dr George Worri Wani NPO /WHE/JGS Hub World Health Organization Gimba Coordinator NAPHS-RSS/007

51 — Mr. Stephen Chol NPO /WHE/LKS Hub World Health Organization

51 Mr. Stephen Chol NPO /WHE/LKS Hub World Health Organization Ga rang Coord inator

52 — Mr. Malick Gai WHE World Health Organization

52 Mr. Malick Gai WHE World Health Organization

53 — Mr. Lasu Robert Data Manger /WHE World Health Organization

53 Mr. Lasu Robert Data Manger /WHE World Health Organization Martin

54 — Dr. Abraham Adut NPHO/ WHE World Health Organization

54 Dr. Abraham Adut NPHO/ WHE World Health Organization

55 — Mrs. Sheila Baya Lab focal Point/ WHE World Health Organization

55 Mrs. Sheila Baya Lab focal Point/ WHE World Health Organization

56 — Mrs. Gloria Brilliant Soc. Mob World Health Organization

56 Mrs. Gloria Brilliant Soc. Mob World Health Organization

57 — Mrs. Rose Dag a ma Data Manger /WHE World Health Organization

57 Mrs. Rose Dag a ma Data Manger /WHE World Health Organization

58 — Mr. Boniface Ambani Health Information Team World Hea lt h Organization

58 Mr. Boniface Ambani Health Information Team World Hea lt h Organization Lead

59 — Mr. Titus Kolongei M& E officer World Health Organization

59 Mr. Titus Kolongei M& E officer World Health Organization

60 — Mr. Alex Freeman WASH Offi cer World Health Organization

60 Mr. Alex Freeman WASH Offi cer World Health Organization

61 — Dr. Antonio Oke WHO AFRO World Hea lth Organization

61 Dr. Antonio Oke WHO AFRO World Hea lth Organization

62 — Dr. lshata Conteh WHO AFRO World Health Organization

62 Dr. lshata Conteh WHO AFRO World Health Organization

63 — Dr. Elisa Ande Butop WHO Nigeria World Health Organization

63 Dr. Elisa Ande Butop WHO Nigeria World Health Organization

64 — Dr. Paul Schumacher WHO HQ World Health Organization

64 Dr. Paul Schumacher WHO HQ World Health Organization

65 — Dr. Miriam Nanyunja WHO AFRO World Health Organization

65 Dr. Miriam Nanyunja WHO AFRO World Health Organization NAPHS-RSS/008 EXECUTIVE SUMMARY Emerging and re-emerging threats with pandemic potential continue to challenge fragile health systems in the African region, creating enormous human and economic toll. The ongoing 10th outbreak of Ebola Virus Disease (EVD) in the neighboring Democratic Republic of Congo (DRC), is already the second largest ever outbreak of EVD following the devastating outbreak in West Africa from 2013-2016. For the neigh boring countries, including the Republic of South Sudan, to effectively mitigate cross-border transmission of EVD, they must be operationally ready to adequately respond. However, substantial resources are needed to engage relevant sectors and partners to systematically implement preparedness actions that will have a lasting impact and contribute of strengthening of core capacities for the IHR (2005). Health security planning and emergency preparedness are essential for the effective implementation of IHR 2005. In line with the regional strategy for health security and emergencies, countries in the WHO AFRO region are assessing their IHR core capacities and subsequently developing national action plans to address capacity gaps identified. Many of the core capacities and much of the infrastructure required for the effective implementation of IHR also contribute to establishing operational readiness for emergencies from all hazards. Investing in emergency preparedness is highly cost-effective, protects lives and safeguards livelihoods and communities. Whether measured in human lives saved or economic disruption avoided, the return on investments in epidemic, pandemic, and emergency preparedness is high. The Joint External Evaluation (JEE) of IHR implementation capacities for South Sudan, conducted in October 2017, confirmed many serious gaps that threaten public health, the environment and economy of South Sudan. The goal of the NAPHS is to build national capacities for the Republic of South Sudan to be a resilient nation that can prevent, detect and respond to any public health threats. The National Steering Committee (NSC) and the Technical Committee (TC) will guide the implementation of the plan. The Minister of Cabinet Affairs is the chairperson of the NSC. The Ministry of Health is the secretariat to the NSC and chair to the Technical Committee. All implementing agencies should make monthly reports to the secretariat who should analyze, consolidate and submit to the steering committee for strategic decision making. The NAPHS incorporates high level recommendations to the Government of the Republic of South Sudan, WHO Country Office & partners, WHO (regional office & headquarters) and other donors on implementation priorities. NAPHS-RSS/009 The NAPHS implementation is estimated to cost about seventy million dollars over the five years of its implementation 2020-2024. The NAPHS cost is a modest investment given the potential lives saved and economic toll averted by the ever-emerging public health threats over the same period. Resource mapping and mobilization are paramount since only 25% of the budget is funded. There is therefore need for all stakeholders to play their respective roles to ensure that South Sudan establishes and maintains the requisite IHR capacities for health security. NAPHS-RSS/010 BACKGROUND The Republic of South Sudan was born in 2011 when it attained its independence from the government of Sudan in Khartoum. It is a landlocked country bordered by Central African Republic to the west, Sudan to the north, Uganda to the south, Ethiopia to the east, Kenya to the southeast, and the Democratic Republic of the Congo to the southwest. The country is home to a population of about 12 million, and it is estimated to be demographically among the youngest nations in the world. The persistent and multiple in country public health challenges and the continued and escalating EVD outbreak in the neighboring DRC emphasizes the need to develop capacities to prevent, detect and respond to public health threats through the implementation of the International Health Regulations (IHR 2005}. South Sudan has also had its fair share of out- breaks having detected and responded to cholera, Rift Valley Fever, malaria, measles, rubella, yellow fever and hepatitis E over the last two years. The country has a nascent health system as seen from health indicators with sub-optimal physical access to primary care, low immunization coverage against vaccine preventable diseases, low capacity to detect outbreaks on time and reduced capacity to respond to outbreaks. The capacity to detect and response to outbreaks in livestock and wildlife is also largely limited by prevailing social service and access constraints. The country has not been declared polio free and has an ongoing measles outbreak since the beginning of 2019. The leading causes of death are infectious diseases though there is an increase in the incidence of non-communicable diseases. South Sudan is committed to attaining Universal Health Coverage, but this will require significant funding, infrastructural and human resources investments into the national health system. There is also a threat of waterborne diseases that contributed to the prolonged cholera out- break of 2014-2019. As highlighted before, the sustainable control and elimination of cholera from South Sudan will require a whole-of government approach that ensures sustainable and predictable investment of resources to ensure populations in hotspot areas have access to improved sources of water and improved sanitation facilities. NAPHS-RSS/011 One of the strategic objectives of the South Sudan Health Development Plan (2012-2016) was to enhance epidemics, emergencies and disaster preparedness and response capabilities through implementing the International Health Regulations. The capabilities include but are not limited to disaster risk reduction, timely detection/confirmation of outbreaks, prompt response and recovery as a means of mitigating the negative outcomes of adverse public health events. The Republic of South Sudan through the Ministry of Health committed to provide the overall leadership and coordination at the highest levels of authority in the health sector for management of health response to Emergencies, Epidemics and Disasters in the country. The ministry also committed to strengthen the Integrated Disease Surveillance and Response (IDSR) capacity from national to subnational levels and designated ports of entry to improve the capacities for early detection, confirmation and prompt response to any Public Health Events of National and International Concern (PHEIC). The NAPHS for South Sudan highlights the following; background, vision, mission, goal and objectives. It also underpins the methodology for the development of the NAPHS, major components of the NAPHS, including top priorities and their costs, implementation, monitoring and evaluation of the NAPHS. NAPHS-RSS/012 International Health Regulations (IHR 2005) Many determinants of health and by extension the implementation of the IHR (2005) capaci- ties are outside the mandate of the health sector. Development and implementation of poli- cies in different ministries, departments and Agencies of Government have a direct influence on health outcomes. Key among these sectors include Ministries of; Health, Interior, Justice, Agriculture, Wildlife, Finance, Security, Transport, Humanitarian Affairs & Disaster Manage- ment, Livestock and all these are to be coordinated by the Ministry of Cabinet affairs. The country will therefore need to develop a one health policy to coordinate the interface of the different Ministries, Departments and Agencies (MDAs) of government in health-related interventions. Monitoring and Evaluation Framework for the IHR. The JEE forms one component of the IHR Monitoring and Evaluation Framework, which guides the implementation of the country's IHR core capacities. The IHR secretariat developed the framework in 2016, in collaboration with related initiatives such as the Global Health Security Agenda and the Performance of Veterinary Services (PVS) Pathway. In engaging with States Parties, WHO is following three principles for assessment, monitoring, and evaluation which include: Country ownership, WHO leadership as custodian of the IHR and Active part- nership. A key tenet is mutual accountability of State Parties and the IHR Secretariat for global public health security through ongoing communication and transparent reporting. Simulation Exercises: SimEx provide an evidence based assessment of functional capacities to respond to emergencies and to strengthen preparedness and response. Exercises are useful tools for identifying and assessing levels of preparedness and may be used at each stage of emergency preparedness development to test the practicality, adequacy, sufficiency, and efficiency of proposed plans and procedures. Multisectoral and multidisciplinary coordination and communication mechanisms are tested regularly through exercises within health as well as whole of government exercises. As part of her preparedness efforts, South Sudan conduct- ed a full-scale simulation exercise to assess capacities for Ebola preparedness at the national level and in the three high risk states of Jubek, Torit, and Yei River on 14th August 2019. NAPHS-RSS/013 After-action Review: Whole-of-government after action reviews for significant events, generate recommendations on potential response improvements. An AAR generally takes the form of a structured, facilitated discussion with those directly involved in the response to analyses best practices, lessons, and challenges. The AAR should take place within three months of the end of the event when the memories of those involved in the event are still fresh. Every country should conduct an AAR after every emergency response, and at least once a year. The After-Action Review for the 2016-2017 cholera outbreak generated lessons for developing the South Sudan National Cholera Control Plan. Situation Analysis by the Joint External Evaluation The situation analysis is largely informed by both the findings and recommendations from the JEE for South Sudan conducted 15th-20th October 2017. Also, the WHE released a benchmarking tool in February 2019 which guides state parties on the key activities needed to achieve the benchmarks commensurate with the level of preparedness that the state intends to achieve. Technical Score Indicators findings areas P.1.1 Legislation, laws, regulations, administrative require me nts, policies or other government instruments in place are sufficient 2 for implementation of IHR (2005) P.1.2 The State can demonstrate that it has adjusted and aligned National its domestic legislation, policies and admin istrative legislation, policy arrangements to enable compliance with IHR (2005) and financing P.1.3 Financing is available for the impl ementation of IHR capacities P.1.4 A financing mechanism and funds are available for the timely response to public health emergencies IHR coordination, P.2.1 A functional mechanism is established for the coordination 2 communication and integrati on of relevant sectors in the implementation of IHR and advocacy P.3.1 Antimicrobial resistance detection P.3.2 Surveillance of infections caused by antimicrobial -resistant Antimicrobial pathogens resistance P.3.3 Healthcare-associated infection (HCAI) prevention and control programs P.3.4 Antimicrobial stewardship activities NAPHS-RSS/014 Technical Score Indicators findings areas P.4.1 Surveillance systems in place for priority zoonotic 3 diseases/pathogens Zoonotic P.4.2 Vete rinary or anim al health workforce 2 diseases P.4.3 Mechanisms for responding to infectious and potential zoonotic diseases are established and f unctional P.5.1 The country has IBS or EBS and monitoring systems in place to monitor trends 2 and detect foodborne events (outbreak or contamination) Food safety P.5.2 Mechanisms are established and functioning for the response and management of food safety emergencies P.6.1 Whole-of-government bio-safety and bio-security system is Biosafety and in place for human, animal and agriculture facilities biosecurity P.6.2 Biosafety and bio-security training and practices P.7.1 Vaccine coverage (measles) as part of national programme Immunization P.7.2 National vaccine access and delivery D.1.1 Laboratory testing for detection of priority diseases National D.1.2 Specimen referral and transport system laboratory D.1.3 Effective modern point-of-care and laboratory-based system diagnostics D.1.4 Laboratory quality system D.2.1 Ind icator- and event-based surveill ance systems 3 D.2.2 Interoperable, interconnected, electronic real-time Real-time 2 reporting system surveillance D.2.3 Integration and analysis of surveil lance data 3 D.2.4 Syndromic surveillance systems 4 D.3.1 System for efficient reporting to FAO, OIE and WHO 3 Reporting D.3.2 Reporting network and protocols in country 2 D.4.1 Human resources available to implement IHR core capacity requ irements Workforce D.4.2 FETP or other app lied epidemiology training programme development in place D.4.3 Workforce strategy R.1.1 National multi-hazard public hea lth emergency Preparedness preparedness and response plan is developed and implemented NAPHS-RSS/015 Technical Score Indicators findings areas R.1.2 Priority public health risks and resources are mapped and utilized R.2.1 Capacity to activate emergency operations Emergency R.2.2 EOC operating procedures and plans response R.2.3 Emergency operations programme operations R.2.4 Case management procedures implemented for IHR relevant hazards. Linking public R.3.1 Public health and security authorities (e.g. law health and enforcement, border control, customs) are linked during a security suspect or confirmed biological event authorities R.4.1 System in place for sending and receiving medical Medical countermeasures during a public health emergency cou nte rm ea su res R.4.2 System in place for sending and receiving health and personnel personnel during a pub lic health emergency deployment R.4.3 Case management procedures implemented for IHR relevant hazards R.5.1 Risk communication systems (plans, mechanisms, etc.) R.5.2 Internal and partner communication and coordination Risk R.5.3 Public communication communication R.5.4 Communication engagement with affected communities R.5.5 Dynamic listening and rumor management PoE.1 Routine capacities established at points of entry Points of entry PoE.2 Effective public health response at points of entry CE.1 Mechanisms established and functioning for detecting and responding to chemical events or emergencies Chemical events CE.2 Enabling environment in place for management of chemical events RE.1 Mechan isms established and functioning for detecting and Radiation responding to radiological and nuclear emergencies emergencies RE.2 Enabling environment in place for management of radiation emergencies NAPHS-RSS/016 VISION, MISSION AND OBJECTIVES OF THE NAPHS - - - - - - - Vision A safe and resilient nation with optimal capacities to prevent, detect timely and promptly respond to any public health threats. Mission To build sustainable national and subnational capacities against public health threats across all lHR technical areas to ensure health security. Goal To enhance national development through adoption of the ONE HEALTH strategy to ensure a healthy human population, livestock, wildlife and environment. Objectives The specific objectives are to: 1. Build, strengthen and sustain the national capacity to prevent, detect and respond to disease outbreaks and other health emergencies. 2. Build a robust health emergency risk assessment & management system aligned with One Health approach. 3. Strengthen the collaboration and coordination mechanisms for NAPHS implementation through application of multi-sectoral and one health approaches. 4. Map existing and potential domestic and external financing to support the delivery of the NAPHS. 5. Build, strengthen and maintain strategic partnerships using a One Health, all-hazards, whole of government and whole of society approach. 6. Develop an effective monitoring and evaluation system for health security through the implementation of the one health strategy NAPHS-RSS/017 GUIDING PRINCIPLESOFTHE NAPHS 1. Country Ownership/ Political buy-in: South Sudan Government leads and coordinates the implementation of the NAPHS, tracks its progress and aligns it with national plans and strategies. 2. Shared responsibility: Global health security is a shared responsibility that cannot be achieved by a single state or sector of government. Its success depends upon collaboration among the health, security, environment and agriculture sectors. 3. Responsive Accountability and Transparency: openness and willingness to share information to facilitate rapid response. 4. Partnership with development partners: The NAPHS upholds South Sudan's partnership with development partners including but not limited to UN agencies, EU, USAID, CDC, Canadian Government, ECHO, DFID, JICA, Norwegian Government, HPF, etc. to protect and promote health security. 5. Evidence-led and prioritization: forward looking to consider emerging trends, risks and health innovations to reinforce timely information sharing and coordinated interventions. 6. Continuous Improvement: Activities, plans and strategies are to be reviewed and improved based on lessons learnt, new evidence, or changes in health threats, policy and legislation. Some NAPHS activities build upon others, therefore flexibility in their implementation is required NAPHS-RSS/018 DEVELOPMENT Of THE NAPHS - - - - - - - - - - - - - The NAPHS development process was led by MOH and line sectors with support from WHO, partners and donors. Review of JEE and Other Assessment Recommendations. Following the finalization of the JEE in October 2017 and the Service Availability and Readiness Assessment (SARA) in 2018, the MOH with the support of partners undertook several initiatives to address gaps and weaknesses identified in the IHR 2005 core capacities. Risk Management Action Plan The Republic of South Sudan needs to strengthen capacities to reduce the health risks and consequences of emergencies and disasters through the implementation of multi-hazard disaster risk management, the IHR (2005), and health system strengthening. The health, economic, political and societal consequences of these events can be devastating. Climate change, unplanned urbanization, population growth and displacement, antimicrobial resistance and state fragility are contributing to the increas- ing frequency, severity and impacts of many types of hazardous events that may lead to emergencies and disasters without effective risk management. In line with risk management, South Sudan will conduct a situational analysis of Anti-Microbial Resistance (AMR); develop the laboratory strategic plan to improve the diagnostic capacity; establish an Infection Prevention & Control (IPC) programme; and other interventions to improve surveillance, laboratory and epidemic preparedness and response. Prioritization of Activities by Technical Area The October 2017 JEE identified key recommendations across 19 technical areas that formed the backbone of NAPHS priorities. The benchmarking tool facilitated the identification of activities for attaining the desired country preparedness level by technical area. The review of the JEE findings culminated into a planning meeting held in August 2018. This meeting gave way to the validation and costing workshop held on 16th-20th September 2019. All these meetings brought together all stakeholders that included line government ministries, departments and agencies whose mandates fall in line with implementation of the IHR (2005). Other stakeholders such as development and implementing partners also played an active role in the prioritization process. Objectives of the planning and costing workshop were threefold; to review recommendations from the JEE report, prioritize realistic interventions against each of the 19 technical areas, and to cost the agreed interventions. NAPHS-RSS/019 Prioritization was done both between and within technical areas due to shortage of operational resources and the limited workforce. Some technical areas were prioritized over the others because the JEE revealed that the country had some demonstrable capacities in some technical areas whereas others had no capacity at all. During the preliminary meetings, the technical working groups had identified ongoing activities, areas that were critical for capacity development, activities that already had committed partners1 support and those that needed minimal or no financial resources to implement. COST ESTIMATES FOR THE NAPHS The NAPHS for South Sudan is estimated to cost about 69 million US dollars whose breakdown is as follows; Table ... ...Showing the cost per technical area Technical Area Budget (USO) Total(%) National Legislation and Financing 1,473,169 2.1% IHR Coordination and Nationa l IHR Focal Point Functions 625,967 0.9% Antimicrobial Resistance (AMR) 1,922,152 2.8% Zoonotic events and the human-animal interface 1,468,086 2.1% Food safety 613,709 0.9% Biosafety and biosecurity 1,518,082 2.2% Immunization 36,961,929 53 .5% National laboratory system 6,327,276 9.2% Real-time surveillance 3,907,102 5.7% Reporting 1,116,072 1.6% Human resources/Workforce development 118,398 0.2% Preparedness 614,431 0.9% Emergency Response Operations 5,908,071 8.6% Linking public health and security authorities 179,101 0.3% Medical countermeasures and personnel deployment 257,494 0.4% Risk communication 3,078,049 4.5% Points of entry (PoE) 2,544,366 3.7% Chem ical events 379,085 0.5% Radiation emergencies 54,520 0.1% Total 69,067,059 100.0% NAPHS-RSS/020 Table ...... Showing the breakdown per broad category Broad Category Budget (USO} Total(%} Prevent 44,583,094 64.6% Detect 11,468,848 16.6% Response 10,037,146 14.5% Other 2,977,971 4.3% Total 69,067,059 100.0% Table ... .. Showing the breakdown per cost center Cost category Budget USO % total Meeting 4,662,664 6.8% Training 6,435,666 9.3% Workshop 1,519,126 2.2% SOP development 41,855 0.1% Communication 57,511 0.1% Construction 3,054,440 4.4% Consultancy 1,633,126 2.4% Evaluation 70,080 0.1% Field visits 10,174,303 14.7% Human resources 5,038,200 7.3% Infrastructure 64,000 0.1% Document reproduction/printing 263,577 0.4% Procurement 17,228,515 24.9% Services 657,920 1.0% Simulation exercises 88,868 0.1% Plaidoyer - 0.0% Study - 0.0% Campaign - 0.0% Operational costs - 0.0% Incentives 16,415,808 23.8% Contingency 825,000 1.2% Monitoring 833,400 1.2% Renovation - 0.0% Total 69,064,059 100.0% NAPHS-RSS/021 Table ...... showing the breakdown per responsible authority Responsible Authority Budget (USD) %total M inistry of Health 60,497,995 88.2% M inistry of Interior 83,070 0.1% Ministry of Fi nance 3,601,841 5.3% M inistry of Agricu lture and Forestry 603,909 0.9% Ministry of Transport - (Civil Aviation) 914,615 1.3% M inistry of Cabinet Affairs 83,400 0.1% M inistry of Petroleum 60,950 0.1% Ministry of Huma nitarian Affa irs - 0.0% SSPDF- (Defe nse Health Services) 179,101 0.3% M inistry of Wi ldlife and Tourism - 0.0% Ministry of Environment 352,215 0.5% M inistry of Justice 709,656 1.0% M inistry of Livestock and Fisheries 1,453,951 2.1% Ministry of Energy and Dams 20,440 0.0% Othe r 2 - 0.0% Other 3 - 0.0% Other 4 - 0.0% Other 5 - 0.0% Other 6 - 0.0% Other 7 - 0.0% Other 8 - 0.0% Other 9 - 0.0% Other 10 - 0.0% Total 68,561,143 100.0% RESOURCE MAPPING AND RESOURCE MOBILIZATION Resource Mapping As with most plans of this magnitude a critical challenge is a gap in resources available to government at national and subnational level and a lack of awareness among key stakeholders at all levels. Under the new Global Programme of Work (GPW 13), the WHO Health Emergencies Programme will contribute heavily to strategic priority of having 1 billion more people better protected from health emergencies. WHO SPH has developed the resource mapping tool as part of the effort to accomplish this objective and strengthen health security. NAPHS-RSS/022 NAPHS is an advocacy tool for stakeholders in the country. It identifies current achievements and implementation gaps that need support. The resource mapping tool will show supported areas, those that are not supported, and will quantify the resources to supported areas. And that will create awareness of areas of gap to strengthen the core capacities in the country. WHO will facilitate a workshop involving the Ministry of Health, representatives of other ministries, and partners including donors to sensitize them on the tool and finalize the resource mapping. Funding gaps and potential funding sources will be identified, including domestic funding. This process will also provide visibility for partner projects and allow policymakers, donors and partners to see where gaps in investment exist. The resource mapping tool will facilitate the harmonization different country plans and recommendations. This process will facilitate the identification of priority activities through the harmonization of different plans. Furthermore, activities will be synchronized among different areas to ensure effectiveness and efficacy of NAPHS. The resource mapping tool will facilitate monitoring countries' progress in completing health security activities and implementing the NAPHS. The outcomes of the workshop will also include, in addition to the visualization of the donor and partner landscape in South Sudan, the creation of a list of priority actions for focused implementation of the five-year NAPHS, broadening of the partner network for health security in the country, and establishment of the tool as a platform to coordinate efforts for NAPHS implementation and build strategic partnerships. Resource Mobilization The provision of adequate funding for IHR implementation through the national budgeting or other mechanisms is essential to ensure availability of resources for implementation and response to public health emergencies at all times. NAPHS implementation shall use an all government approach drawing on the Public Private Partnership linkages. Resources will be integrated in the sector budgets and additional resources mobilized from within government and partners. NAPHS-RSS/023 Domestic resources mobilization (Government annual budgetary allocation to line Ministries) in addition to donor contributions will finance the plan. The NAPHS activities costing will be integrated into the pertinent ministries request for budget every year, and additional resources mobilized from within government and partners. The role of the Ministry of Health will be to strengthen the health components of the IHR core capacities, leads the development and implementation of the NAPHS and mobilize resources for the implementation. Resource will be mobilized also through grant writing/ application, strategic partnerships, etc .... Donors and partners should completement and support government to mobilize resources .. This support will be realized through organizing partnership forum meeting for resource mo- bilization. Collaboration with internal and external partners, agencies and organizations is essential. WHO will support in identifying, facilitating and coordinating with external partners for resource mobilization. There is also a need for increased high-level advocacy for additional resources to support implementation as well as capacity building to address capacity gaps across the country. IMPLEMENTATION, MONITORING AND EVALUATION OF THE NAPHS Overall Governance of the NAPHS implementation The National Steering Committee (NSC) and the Technical Committee (TC) will guide the implementation of the plan. The Minister of Cabinet Affairs is the chairperson of the NSC. The Ministry of Health is the secretariat to the NSC and chair to the Technical Committee. The Director General in charge of International Health and Coordination in MOH is the chairper- son of the National Focal Point (NFP) for IHR implementation. The ministry of cabinet affairs will designate an officer at the level of a Director General to coordinate IHR implementation in an all-of government and one health approach. It is therefore the cabinet affairs ministry that will convene other government ministries, departments and agencies to implement the NAPHS. NAPHS-RSS/024 Technical Committee The NFP chairperson will lead the technical committee with representation from all the implementing government ministries, departments, agencies and the key donors. All the Technical Working Groups (TWGs) highlighted in the NAPHS implementation matrix will be forwarding their meeting resolutions to the Technical Committee for action and feedback. The TC playing the technical coordination role of the NAPHS implementation will synthesize these resolutions, give feedback to the TWGs and further inform the NSC on the progress made. National Steering Committee Purpose The purpose of the National Steering Committee (NSC) is to oversee and, when necessary, to coordinate development and implementation of the national action plan for health security in all sectors to guarantee a systematic, comprehensive approach. Scope The NSC should address all aspect of the NAPHS framework from inception, development and implementation related activities in country. The scope should be broad enough to address all three strategic steps of NAPHS framework. Role and responsibilities Leadership The IHR NSC will lead facilitation and, when appropriate, coordination of development, imple- mentation and monitoring of the NAPHS. Its leadership could take the form of officially dele- gated authority, with more formal procedures and official monitoring, evaluation and report- ing. Facilitation and coordination The IHR NSC should facilitate and, when appropriate and agreed, coordinate efforts to devel- op and implement the NAPHS. The IHR NSC should facilitate on building a collaborative, coop- erative, supportive environment for sharing knowledge, information and experience. Each participating party should understand the scope and limits of its contributions and also its inter-dependence with other parties and with the whole system to meet the defined goals. Political support and selection of a chairperson (recommended on a rotational basis) with appropriate status and leadership skills are critical factors. External interactions Collaboration with internal and external partners, agencies and organizations is essential for many countries. WHO offices can support Member States in identifying, facilitating and coordinating with external partners for resource mobilization. NAPHS-RSS/025 Internal interactions The NAPHS should link with national sectoral development plans, emergency preparedness and response plan and specific disease related programmers. The nature of these internal interactions and the results will depend on the country. As many agencies and programmes have responsibilities in the NAPHS, a guiding principle of the IHR NSC is to find, at the highest levels of government, the most suitable ways to facilitate and provide synergy with new or existing work to accomplish programme objectives. Furthermore, the IHR NSC must be appro- priately integrated and have clearly defined roles and responsibilities in existing health system, animal health and other relevant sectors. Membership The national Technical Committee (TC) should be composed of high level (institutional leadership level) members representing the relevant sectors, notably human health, animal health, finance, environment, justice and other sectors and based on stakeholder analysis. Delegated representatives should be given enough authority (written) by their institutions to make immediate decisions. While it is important to have enough representation of these key stakeholders, the IHR NSC should remain small enough to be functional, striking a balance between full representation and the functionality of the group. Meeting format and rules The meeting format and rules should conform to national norms. Standard operating procedures may be elaborated, transparently and according to the principles of best practice, to guide the activities of the steering group. The responsible minister(s) should select a chairperson based on his or her expertise in leadership. Rotation of the chair among members of the IHR NSC could be considered, as could be the elevation of the chair to the supra-ministerial level (office of the President or Prime Minister) Members should be selected to ensure that all relevant stakeholders are equitably represented. The stakeholders may be requested to recommend members. Still, the chairperson (with the support of the secretariat) should ensure that the recommended members have adequate skills, knowledge, authority and influence and can collaborate. It is prudent to attain a gender balance. The IHR NSC should be reinforced by an appropriately resourced secretariat responsible for the logistics of meetings; minute-taking; preparation and circulation of documents background papers, reports and advisory notes to ministers; and management. Preferably, the head of the secretariat will be the national IHR focal point. It is recommended that the group have a mechanism (with appropriate records) to ensure that its members have no conflicts of interests and that the work of the IHR NSC in the interests of public health is transparent. NAPHS-RSS/026 Reporting, Monitoring and Evaluation. All implementing agencies should make monthly reports to the secretariat who should ana- lyze, consolidate and submit to the steering committee for strategic decision making. Monthly meetings for the implementing ministries, agencies and other implementing part- ners will be held through the TWGs and reports submitted to the Technical Committee. The TC will be meeting quarterly to analyze and deliberate on the resolutions from the TWGs for approval and guidance. The steering committee will be meeting on a semiannual basis. Annual performance reviews will be conducted and should bring in more stakeholders Midterm review is expected to be done in the 1st half of 2023. High Level Recommendations A. Government of the Republic of South Sudan: 1. Strengthen the national IHR NFP as secretariat for NAPHS implementation 2. Establish integrated, multi-sectoral, One Health high-level and technical platforms such as an IHR Technical Working Group/National Steering Committee with the IHR National Focal Point as the secretariat for the oversight of the implementation of the NAPHS. 3. Develop specific linkages at policy and operational level to connect NAPHS with broader national budgeting, planning and implementation cycle (including feeding into the 2019 and subsequent South Sudan Humanitarian Response Plans, Pillar 5 of the EVD Strategic Response Plan (SRP 4). It is also important to identify opportunities for integration of the NAPHS into other national campaigns and programs for Universal Health Coverage (UHC) and health related Sustainable Development Goals (SDGs). 4. Establish, review and update the key pieces of legal documentation to bring the country's legal framework in line with IHR 2005. Consideration should be given to legal instrument establishing a dedicated port health entity. 5. Strengthen advocacy for IHR and cross border collaboration with relevant national, regional and international bodies and partners; to jointly ensure capacity building, collaboration and mobilization of partners to assist and support the activities of the NAPHS in terms of technical assistance, financial and material resources. 6. Develop and implement advocacy plans and secure commitment at all levels of government for allocation of domestic financing for sustainable implementation of NAPHS. 7. Develop a strategy for both internal and external resource mobilization to support the implementation of NAPHS activities. NAPHS-RSS/027 8. Urgent attention should be given to the development of a strategy for IHR workforce development. 9. Develop annual operational plans for implementation of prioritized actions in the NAPHS with a robust monitoring and evaluation mechanism to ensure timely and effective implementation of planned activities and milestones. 10. Document and share lessons learnt and best practices on IHR implementation in complex settings. B. WCO and In-Country Partners 1. Provide leadership, technical guidance, assistance, and support to the finalization and phased implementation of the NAPHS. 2. Support the government to implement all the above recommendations. 3. Support the engagement of a full-time technical officer (consultant) to support the NAPHS finalization, launch, and inception of phased implementation. 4. Support development of annual operational plans for implementation of prioritized actions. 5. Support the development of a detailed and well laid out monitoring and evaluation plan to track the progress of the NAPHS by a full-time technical officer (consultant). 6. Advocate with national authorities for domestic financing of NAPHS activities through relevant entities and line ministries. 7. Support coordinated fora for joint review of implementation of progress with the leadership of the review. C. WHO and international Partners: 1. Advocate for and facilitate strategic partnership opportunities for international financing. 2. Provide leadership, technical guidance, assistance, and support to the in-country entities in their support to the government's various line ministries and entities. NAPHS-RSS/028 3. Advocate and provide support to the in-country entities for the implementation and monitoring of the NAPHS. 4. Provide technical guidance and assistance to help harmonize the implementation of the various initiatives, plans and tools. 5. Support coordinated fora for joint review of NAPHS implementation and progress on IHR core capacities with the leadership of the national authorities. 6. Provide technical support for IHR and DRM implementation to strengthen Emergency Preparedness and Response (EPR). COMPONENTSOFTHENAPHS PREVENT NATIONAL LEGISLATION, POLICY AND FINANCING Target Adequate legal framework for States Parties to support and enable the implementation of all their obligations, and rights to comply with and implement the IHR {2005). New or modified legislation in some States Parties for implementation of the IHR {2005). Where new or revised legislation may not be specifically required under the State Party's legal system, States may revise some legislation, regulations or other instruments to facilitate their implementation and maintenance in a more efficient, effective or beneficial manner. States Parties ensure provision of adequate funding for IHR implementation through the national budget or other mechanism. South Sudan Level of Capabilities The country has legislation and several regulations and administrative documents that govern public health surveillance and response. They include: The Transitional Constitution of the Republic of South Sudan {2011), the National Health Policy {2016-2026); the draft National Health Sector Development Plan {2017-2021); the Environmental Policy {2015-2025); the Drug and Food Control Authority Act {2012); National Disaster Risk Management Policy {2016); the Petroleum Act {2012); the HIV/AIDS Commission Act {2006); the General Medical Council Provisional Order {2014) and the Civil Aviation Authority Act {2012). However, the launch of other relevant acts such as the Public Health and Animal Health bills have been delayed at the Ministry of Justice and Constitutional Affairs, and therefore need to be expedited. The country carried out a desk review on available legislation and regulations for IHR {2005) implementation NAPHS-RSS/029 in December 2015. It was however noted that a more comprehensive review must be done to inform the review of key legislation. Although the government has provided financial support to recent outbreaks of cholera, information on dedicated government budget for emergencies was not readily available Responsible Budget in Activity Authority US Dollars Objective 1: To ensure adequate administrative and statutory provisions are available for Implementation of IHR by 2022 1.1 One day seminar for 30 Stakeholders from relevant authority 1840 Ministry of to sensitize on IHR and develop a road map for passing the Justice pending bills. 1.2 Conduct annual meetings to review implementation of the Ministry of 9200 road map for passing the pending bill Justice 2.1 one day meeting with 40 stakeholders' representatives to Ministry of 4740 sensitize on the updated laws Justice Ministry of 133600 2.2 Dispatch the sensitization teams to 32+1 states Justice Ministry of 8700 2.2 conduct sensitization training in 3 zones Justice 3.1 Conduct One national annual meeting with neighboring 17650 Ministry of countries to review, validate and mon itor implementation of the Health MOUs 3.1 Conduct Four 3 subnational meetings with neighboring 162700 Ministry of countries to review, validate and monitor implementation of the Health MOUs 3.2 Form joint committees to mon itor implementation of MOUs Ministry of 378000 and agreed guidelines Health 4.1 Two-day meeting by line sectors {Health, Agriculture, Livestock 21700 &Fisheries, Environment, Interior, Justice etc.) to finalize the Ministry of budget Line for IHR and submit to MOF for fund approval and Justice allocation 4.2 Convene a meeting with Ministry of Finance & Member of Ministry of 24100 Parliament to present the consolidated IHR budget Justice NAPHS-RSS/030 Objective 2. Comprehensive desk review of national laws touching on IHR (2005) Implemented Conduct a one-day meeting of stakeholders (30 participants) to Ministry of 5520 identify Internal and external IHR funders Justice Ministry of 44670 1.2 Conduct 3 days' workshop for 30 participants Justice 1.1 Hiring of 2 medico-legal consultants (1 Internationa l) to 61320 Ministry of conduct a desk review of the existing laws and facilitate the 3 days' Health workshop (Three-month Consultancy) 1.1 Hiring of 2 medico-legal consultants (1 national) to conduct a 41040 Ministry of desk review of the existing laws and facilitate the 3 days' workshop Health (Three-month Consultancy) 10500 Specialized Committee members (10} within National Parliament to Ministry of convene and come up with bill to be enacted by the parliament Justice 1.2 Conduct biannual meetings to follow up on progress of the 153390 Ministry of legislative amendments (hall hire for one day, DSA, Meals, Justice Transport, Facilitation) 1.3 Conduct consu ltative Five (5) meetings (2 national & 3 sub- 5240 national) to solicit stakeholder opinions on the proposed legislative Ministry of amendments (hall hire for one day, DSA, Meals, Transport, Justice Facilitation) 74730 1.3 Conduct consultative Five (5) meetings (2 national & 3 sub- Ministry of national) to solicit stakeholder opinions on the proposed legislative Health amendments (hall hire for one day, DSA, Meals, Transport, Ministry of 3300 1.4 Typing, designing and printing of reviewed laws Justice Ministry of 2535 To review all Bills (Pending, Passed and Required) Justice To conduct 1-day stakeholders advocacy workshop to review bill Ministry of 10230 status, Justice 500 Printing of the ready or passed Bill (Public Health Bill, Drugs and food control authority acts, National Health Policy, Policy framework and strategic plans 2012-2016, Revised Technical Ministry of guideline-lDSR 2013, Disaster Risk Management Policy, Barna Health Initiative Bill, National Health Sector Strategic Plan 2017- 2021, Assessment of Public Health Core Capacities for IHR 2015) Justice / ~ / NAPHS-RSS/031 Sensitize 9 specialized committees of the different pending bil ls M inistry of mentioned above to lobby for enactment of the bills Justice M inist ry of 83400 Conduct a specia l sitting of Nationa l Legislative Assembly to enact Cabi net pending laws Affairs M inist ry of 82500 Printing of the ORM Pol icy Justice M inist ry of 22176 Dissemination of DRM pol icy t o 33 St ate Justice M inistry of 109888 Training for Disseminators Justice I HRCOOR DI NATION, COMMUN ICATION AND ADVOCACY TAGETS Multi sectoral/multidisciplinary approaches through national partnerships that allow efficient, alert and responsive systems for effective implementation of the IHR (2005). Coordinate nationwide resources, including sustainable functioning of a national IHR focal point- a national center for IHR (2005) communications which is a key requisite for IHR (2005) implementation -that is always accessible. States Parties provide WHO with contact details of national IHR focal points, continuously update and annually confirm them. South Sudan level of capabilities The Ministry of Health has designated the Directorate of International Health and Coordination (IH&C) to oversee IHR implementation. The Directorate is yet to be staffed and provided with the requisite logistics for it to be fully functional. Access to the National IHR Focal Point (NFP) is thus limited. There is an OIE delegate, however, there are no IHR focal persons for food safety and relevant sectors such as security agencies, immigration, chemical events, and radiation emergencies. There exists a National Emergency Preparedness and Response (EP&R) taskforce that holds a weekly meeting and predominately oversees activities related to infectious diseases. The membership of the taskforce does not include all key stakeholders and varies based on type of disease outbreak or event. The National IDSR program currently collects and analyses alerts and disease outbreaks and provides a platform for information sharing for some potential epidemic-prone diseases. The country has been able to carry out an After-Action Review after a cholera outbreak and provided feedback to stakeholders. Generally, there is no formalized structure for coordination and communication between relevant ministries and other stakeholders on events of national and international interest. This gap often leads to duplication of efforts and delayed response. NAPHS-RSS/032 Responsible Budget in Activity Authority US Dollars Objective: To strengthen IHR NFP for effective coordination, communication and advocacy 1.1 Formation of IHR coordination and communication committee 34436 at national level (Each from relevant stakeholders), develop ToRs Ministry of Health and Orient Committee members (2-days meeting involving 40 participants) 1.2 Conduct annual meeting of the IHR C&C Committee to 148305 address any national or international health concern (1-day Ministry of Health meeting involving 40 partic ipants) 2.1 Develop TORs and recruitment two (2) Public Health Officers 240000 Ministry of Health to support the IHR NFP 2.2 Adapt; va lidate; and launch the SOPs for the IHR NFP (2-days 12500 meeting involving 30 participants to review and adapt the IHR Ministry of Health NFP SOPs) 2.3 Print and disseminate the IHR NFP SOPs Ministry of Health 1515 2.4 Establish and assign offices for IHR as department (headed by 10000 a Director) under International Health & Coordi nation Directorate Ministry of Health in MOH 3. 1 Train the IHR NFP and support staff on the national IHR NFP 16100 SOPs (2-days meeting for 20 people [IHR NFP and sectoral IHR Ministry of Health focal points]) 3.2 Procure office equ ipment and stationeries for IHR department Ministry of Health 37250 Operational costs (internet monthly access) Ministry of Health 30000 4.1 Develop TOR for IHR NFP TWG and one-day meeting to 29661 designate and sensitize the TWG members (one day meeting for Ministry of Health 40 participants). 4 .. 2 Conduct monthly meetings of the IHR TWG meetings at 53700 PHEOC to review ongoing PH events; and guide the NFP functions Ministry of Health and report back to the IHR committee. 2.2 Adapt; va lidate; and launch the SOPs for the IHR NFP (2-days meeting involving 30 partic ipants to review and adapt the IHR Ministry of Health NFP SOPs) NAPHS-RSS/033 ANTIMICROBIAL RESISTANCE TARGETS Support work coordinated by FAO, OIE and WHO to develop an integrated global package of activities to combat antimicrobial resistance, spanning human, animal, agricultural, food and environmental aspects (i.e. a One Health approach). Each country has: (i) its own national comprehensive plan to combat antimicrobial resistance; (ii) strengthened surveillance and laboratory capacity at the national and international levels following international standards developed as per the framework of the Global Action Plan; and (iii) improved conservation of existing treatments and collaboration to support the sustainable development of new antibiotics, alternative treatments, preventive measures and rapid point-of-care diagnostics, including systems to preserve new antibiotics. South Sudan level of capabilities Antimicrobial resistance (AMR) is an issue of huge global importance and therefore strong actions must be undertaken by every country to control it. South Sudan currently has no AMR reference laboratory but has a designated NPHL in Juba that could be used for this function. There is no national plan for the detection and reporting of AMR pathogens and there are no Health Care Associated Infection (HCAI) sentinel sites. Furthermore, there is no mention of AMR pathogens in the National Public Health Laboratory Strategic Plan 2010-2015. The National TB program has demonstrated capacity for the detection of rifampicin resistance, but this does not extend to any other priority pathogens. There is no surveillance for AMR in animal populations. No antimicrobial stewardship plans exist, and neither are laws on appropriate prescription of antibiotics, thus making them easily available over the counter. Responsible Budget in US Activity Authority/Budget Dollars holder Objective 1: To establish a system for AMR detection 1.1 One day planning meeting for 20 persons drawn from MOH National level, NPHLS, major hospitals (public & private) and Ministry of Health 1310 Teach ing Institutions to develop plan of action for AMR 1.2 Hire a technical consultant for a period of 20 working days Ministry of Health 20440 to support the development of the AMR plan of action 1.2 Hire a techn ical consultant for a period of 3 months to Ministry of Health 4560 ,,. support the development of the AMR plan of action ---~ NAPHS-RSS/034 Responsible Budget in US Activity Authority/Budget Dollars holder 1.3 One Day validation meeting for 15 persons (6 Pax from three greater regions; Greater Bahr Ghazal, Greater Equatorial, Ministry of Health 2707 Greater Upper Nile) 1.4 Printing of validated AMR plan of action Ministry of Health 224 1.5 Launching of AMR validated action plan high level meeting Ministry of Health 15231 for 20 persons 1.6 Develop guidelines and SOPs on AMR prevention and Ministry of Health 20440 control 1.7 Two Day Workshop to validate, launch and disseminate Ministry of Health 18260 guidelines and SOPs on AMR prevention and control 1.9 Printing of 64 validated AMR Prevention and Control Ministry of Health 448 guidelines and 64 SOPs (70 pages each) 2. 1 One Day meeting to develop, review and validate draft TOR Ministry of Health 15231 for the AMR TWG 2.2 One Day quarterly meeting for AMR Prevention and Control Ministry of Health 17800 TWG (20people). Refreshments and tea 3.1 Designation of selected laboratory as national AMR focal Ministry of Health 0 laboratory (Secure official letter from the national MoH) 3.2 Designate one AMR Focal Person for each site (Juba, Wau, Malakal) in-consultation with line MoHs, refer to nominal roll Ministry of Health 124200 public service Ministry of Labor for salary scale and grade 3.4 Five (5) day AMR Testing Training for 15 Laboratory Technicians from NPHL, JTH, Military Hospital, Alsabah Children Ministry of Health 46250 Hospital and the vet labs 3.5 Hire national consultant for 60 working days to deliver bench mentorship during AMR Testing Training and Ministry of Health 39280 implementation at the three sites {20 days per site) 3.6 A one (1) day training for 20 participants to integrate AMR specimen management into the National specimen referral Ministry of Health 17240 system 4.1 Hire a consultant for one (1) month to support desk review Ministry of Health 20440 of existing sources of AMR data 4.2 One-day Planning meeting for 30 persons for survey to Ministry of Health 4610 ascertain AMR prevalence (facilitated by the above consultant). 5.1 Engage a consultant for one (1) month to incorporate AMR Ministry of Health 20440 reporting into existing systems 5.2 Two-day ToT training on DHIS2 AMR module Ministry of Health 6932 NAPHS-RSS/035 Responsible Budget in US Activity Authority/Budget Dollars holder 1.1 Conduct a Needs Assessment and develop tools for AMR 0 Ministry of Health Surveillance 1.2 Develop tools for AMR Surveillance for two days and 0 piloting for One day within Juba, then another two days after to NPHL finalize the tools 1.3 Print, launch and disseminate the reporting form Ministry of Health 0 1.4 Collect and analyze data for AMR surveillance, 5 days TOT 0 training in Juba on data collection 4 from Juba, 3 Malakai and 3 Ministry of Health Wau. Cascade the training to the state levels 2.1 5 Batches of 5-Day residential training on surveillance for 19754 Ministry of Health program officers 4.1 One Day planning meeting on awareness creation for AMR 15602 Ministry of Health (20 persons) 4.2 Engage consultant to develop information, communication 20440 Ministry of Health and education (IEC) materials for print and electronic media Develop an IPC policy, guideline and action plans Ministry of Health 20440 4.4. Identify and nominate a focal person for IPC at National 0 and Health facility level in the former 10 hubs 4.5. Create an IPC National steering Committee for national and 0 state level in the former 10 hubs One day meeting of steering committee Ministry of Health 30462 ObJedlve 2: Establish surveillance systems to Identify and monitor AMR path01ens 1.1 Conduct a Needs Assessment and develop tools for AMR Ministry of Health - Surveillance 1.2 Develop tools for AMR Surveilla nce for two days and Ministry of Health piloting for One day within Juba, then another two days after to - finalize the tools 1.3 Print, launch and disseminate the reporting form Ministry of Health - 1.4 Collect and analyze data for AMR surveillance, 5 days TOT Ministry of Health training in Juba on data collection 4 from Juba, 3 Malakai and 3 - Wau. Cascade the training to the state levels 2.1 5 Batches of 5-Day residential training on surveillance for Ministry of Health 19,754 program officers 4.1 One Day planning meeting on awareness creation for AMR Ministry of Health 15,602 (20 persons) 4.2 Engage consultant to develop information, communication Ministry of Health 20,440 and education (IEC) materials for print and electronic media Develop an IPC policy, guideline and action plans Ministry of Health / 20,440 NAPHS-RSS/036 Responsible Budget in US Activity Authority/Budget Dollars holder 4.4. Identify and nominate a focal person for IPC at National Ministry of Health - and Health facility level in the former 10 hubs 4.5. Create an IPC National steering Comm ittee for national and Ministry of Health - state level in the former 10 hubs One day meeting of steering committee Ministry of Health 15,231 4.3 Print and disseminate IECs Ministry of Health 4,300 ObJedlve 3· Develop/establish and lnstltutlonallze a national lnfedlon prevention and control (IPC) programme 1.1 Engage consultant for national IPC programme Ministry of Health 20440 development 1.2 one (1) Day Planning meeting for IPC programme Ministry of Health 112340 development (20 persons) 1.3 one (1) day workshop for National IPC Programme Ministry of Hea lth 11234 development (20 participants) 1.4 Two (2) Day va lidation and dissemination of National IPC Ministry of Health 21289 programme pol icy document 32+1 states 1.5 Print National IPC program policy document and guidelines Ministry of Health 448 Periodic (annual) IPC health facility assessments using the standard WHO assessment tool (Quarterly visits will be undertaken by a team of 10 National IPC experts who w ill travel to the states to work with the state IPC team for 7-l0days Ministry of Hea lth 8610 where they will visit and conduct assessments in a representative sample of health facilities stratified by level (i.e. state hospital; county hospita l; PHCC; PHCU 1.6 One (1) day meeting to disseminate National IPC program Ministry of Hea lth 15231 policy document and guidelines (33 participants) 2.1 Designate IPC focal persons in all healthcare facilities and create a database of all I PC focal persons with contact details (e Ministry of Hea lth 0 mail address and phone numbers) 3.1 Conduct quarterly field visits to assess the burden of HCAI 4 Ministry of Hea lth 57856 pax pe r state in 4 &-hospita ls 3.2 Disseminate the result from the assessment on the burden Ministry of Health 0 4.1 Conduct annual review meetings on HCAI for 2 days between the national and state levels for 20 pax; hire a hall and Ministry of Health 73040 refreshments 4.2 Conduct annual three days consultative meeting between ,, MoH, ministry of Labor, MLF, Ministry of Higher Education, 85156 / Ministry of Justice and Parliamentary Affa irs for 33 participants to establish occupational health program for health workers / NAPHS-RSS/037 Responsible Budget in US Activity Authority/Budget Dollars holder Objective 4 To establish antlmlcroblal resistance stewardship to promote appropriate use of antibiotics and monitoring Please refer to AMR policy, plans and guidelines not yet Ministry of Health 20,440 developed but is being plan and costed already Hire the same consultant to put on a policy, and regulations on Ministry of Health 11,234 antibiotics use in human Have annual 2 days meeting to review an update the guidelines Ministry of Health 11,234 on antibiotic use for 20 pax Please refer to AMR policy, plans and guidelines not yet Ministry of Health 21,289 developed but is being plan and costed already Use the guideline in the algorithm to include prescription consumption patterns in both human and an imals by Ministry of Health 448 conducting joint monitoring supervisory field visits one hea lth quarterly Form a stewardship committee in health facilities level in the 10 Ministry of Health 15,231 former hubs To carry out awareness and sensitization in the community leve l thru IEC materials and rad io talk shows. (One hea lth approach Ministry of Health - and physicians and Doctors) To carry out awareness and sensitization in the commun ity level th ru IEC materials and radio talk shows. (One health approach Ministry of Health 3,616 and physicians and Doctors) Quarterly review meetings in Malakai, Juba, and Wau Ministry of Health - 10 pax coming from each site Periodic review (semiannual) meetings for the three sites of Ministry of Health 18,260 Malaka i, Juba, and Wau To carry out awareness and sensitization in the community leve l th ru IEC materials and radio talk shows. (One hea lth approach Ministry of Health 21,289 and physicians and Doctors) To carry out awareness and sensitization in the community leve l th ru IEC materials and radio talk shows. (One health approach Ministry of Health - and physicians and Doctors) Quarterly review meetings in Malakal, Juba, and Wau Ministry of Health 20,440 10 pax com ing from each site Periodic review (semiannual) meetings for the three sites of Malaka i, Juba, and Wau Ministry of Health 21,289 I/ ,,. NAPHS-RSS/038 ZOONOTIC DISEASES TARGET Adopted measured behaviors, policies and/or practices that minimize the transmission of zoonotic diseases from animals into human populations. South Sudan level of capabilities The country recognizes that zoonotic diseases contribute significantly to the burden of human disease in the region and that South Sudan is not immune to the impact of zoonotic diseases on human health. In this regard the country has identified zoonotic diseases of the greatest public health concern, which include Ebola, Yellow Fever, cutaneous anthrax, brucellosis, bovine TB, highly pathogenic avian influenza (HPAI), rabies and Rift Valley Fever. South Sudan has a large animal population, including domestic, commercial and wild animals, although a census of animal populations was last performed in 2007. The Ministry of Live- stock and Fisheries has developed an animal health policy and strategic plan (2012-2016), however, the timeframe of this document has elapsed. A revised/updated document was not available at the time of the evaluation. Surveillance systems are in place for detection and reporting of priority zoonotic diseases that pose the greatest risk to humans, through the IDSR, and animal health through the Animal Epidemiology Disease Information System. Comprehensive outbreak guidelines and reporting forms are available for zoonotic disease outbreaks. The country is yet to establish a One Health policy. Currently the human and animal health sectors are not coordinated with interactions and operations happening on an ad hoe basis. Responsible Budget in US Activity Authority Dollars Objective 1: Strengthen an Integrated zoonotlc disease surveillance system for priority zoonotlc pathogens of public health concern Develop and launch one health policy for zoonotic diseases in Ministry of Livestock 20,440 South Sudan and Fisheries Prepare OH Advocacy and Sensitization Materials (6 Ministry of Livestock 3,550 participants, 2facilitators for 3 days meeting) and Fisheries Print and dissem inate copies of One Health Advocacy Ministry of Livestock 3,000 materials to all counties and Fisheries 1.3 Conduct stakeholder workshop for developing National Ministry of Livestock I/ One Health Strategic plan draft (SO participants, 4 facilitators 62,406 and Fisheries for 5 days) NAPHS-RSS/039 Responsible Budget in US Activity Authority Dollars 1.4 Conduct workshop to finetune the Nationa l One Health Ministry of Livestock 2,440 Strategic Plan (10 participants,2 facilitators for 3days). and Fisheries 1.5. Hire 1 consultant for 21 days to develop and Ministry of Livestock 14,788 operationalize the National One Health Strategic plan and Fisheries Ministry of Livestock 1.6. Validation workshop for 2 days for SO participants 12,820 and Fisheries 1.7. Print and dissem inate copies ofthe National One Health Ministry of Livestock 3,000 Strategic plan for the states/counties and Fisheries Train and deploy a multidisciplinary RRT to conduct a joint risk assessment for two days to prioritize zoonotic diseases Ministry of Livestock 306,900 and strengthen priority zoonotic disease surveil lance at state and Fisheries and county levels (5 RRT members in each of the 32+1 states) 1.10 Orientation train ing of the One Health secretariat 5 Ministry of Livestock 1,080 personne l, 2 facilitators for 2 days and Fisheries Conduct a Joint Risk Assessment to Prioritize zoonotic Ministry of Livestock 17,815 diseases for South Sudan and Fisheries 2.0. Conduct Workshop to draft the guidelines ,Sdays,20 Ministry of Livestock 6,250 participants and 2 facilitators and Fisheries Ministry of Livestock 2.1. Two days Validation workshop ,30 participants 10,714 and Fisheries Ministry of Livestock 2.2. Printing and dissemination 100 copies of the guidelines 1,000 and Fisheries 3.1 Conduct meeting with National & States Laboratory Ministry of Livestock Directors general from relevant ministries {2 days ,40 28,250 and Fisheries participants & 2 facilitators. 3.2. Launching the National Laboratory Network {200 Ministry of Livestock 9,530 persons) and Fisheries Ministry of Livestock 4.1 Conduct awareness programmes on TV, radio (TV airtime, 3840 and Fisheries 4.2 Conduct annual awareness meetings with the community Ministry of Livestock 17,392 leaders at 32+1 States and Fisheries Objective 2: Increase anlmal health workforce capacity at national level and In at least 80 percent Counties levels by 2024 A one-day workshop that will map a multidisciplinary Rapid Ministry of Livestock / Response Team from relevant sectors that will support joint 1,996 and Fisheries response, 32 participants. / NAPHS-RSS/04O Responsible Budget in US Activity Authority Dollars Conduct training FELTP for the national level staffs (10 Ministry of Livestock national staffs) and engage a consultant for the period of the 1,064 and Fisheries train ings Conduct train ing FELTP for the national level staffs (10 Ministry of Livestock national staffs) or engage a consultant for the period of the 4,000 and Fisheries train ings 1.1. Train Human and Animal Hea lth frontline workers on Ministry of Livestock 16,150 FELTP basic level {64 Staffs) and Fisheri es 1.2. Train Human and Animal Hea lth workers FELTP Ministry of Livestock 31,122 intermediate level {32 Staffs) and Fisheries 1.3. Train Human and Animal Hea lth workers on FELTP Ministry of Livestock 6,250 advanced level (20 Staffs) and Fisheri es Ministry of Livestock 2.1 Procure laboratory supplies and equipment 500,000 and Fisheries 2.2 Training of laboratory personnel on use calibration and Ministry of Livestock maintenance of equipment for 2 days, 20 participants, 2 2,620 and Fisheries faci Iit at ors 2.3 Training of laboratory technician on diagnosis/detection Ministry of Livestock of zoonotic pathogens for 3 days, 20 participants, 2 3,530 and Fisheri es faci Iit at ors Ministry of Livestock 3.2 Consultants tender advert 5,000 and Fisheries 3.3 Hire Two National and Two International consultants for Ministry of Livestock thirty (30) days to develop a master plan for the construction 8,912 and Fisheries of Veterinary Infrastructures, 30 participants. 3.4. Two days validation workshop of draft of the master plan Ministry of Livestock 6,556 for 40 participants both residents and non -residents and Fisheries 3.5. Submission of the validated draft to the council of Ministry of Livestock - ministers for approval and Fisheries Objective 3: Establish a multl-sectorlal mechanism for coordinated response to outbreaks of zoonotlc diseases at national and state levels 1.1 Conduct a one-day top level management meeting to Ministry of Livestock 3,050 estab lish a reporting system in the anima l health sector. and Fisheries 1.2 Install DHIS2 database for information storage and Ministry of Livestock 23,816 management system in animal health laboratory and Fisheries Setting up a coordination office for a veterinary focal point Ministry of Livestock 240,000 and recruiting a foca l person with MoH who will engage with and Fisheries the relevant line sectors in zoonotic diseases ~ I/ NAPHS-RSS/041 ----------- Responsible Budget in US Activity Authority Dollars Ministry of Livestock Procure office furniture and IT equipment 9,500 and Fisheries Setting up a coordination office for a veterinary focal point 120,000 and recruiting a focal person with MoH who w ill engage w ith Ministry of Health the relevant line sectors in zoonotic diseases FOOD SAFETY TARGET Surveillance and response capacity among States Parties for food- and water-borne disease risks or events ensured by strengthening effective communication and collaboration among the sectors responsible for food safety, and safe water and sanitation. South Sudan level of capabilities The regulatory system for food safety in the Republic of South Sudan is in the developing stages, with political will and commitment of the Government of South Sudan demonstrated by its membership of the CODEX Alimentarius. A CODEX Committee is in existence, with membership from different sectors and a vision to align with CODEX guidelines, standards and recommendations for food safety. The stakeholders identified and included in the committee include the MOH, Drug and Food Control Authority, Ministry of Agriculture and Food Security, Ministry of Livestock and Fisheries, Ministry of Trade and Industries, Ministry of Environment and Forestry, Office of the President for National Security, and the National Bureau of Standards. Other stakeholders include multilateral agencies like FAQ and WHO. Focal points across different sectors exist, and this multisectoral approach has the potential of driving the vision of ensuring standards and protecting the public from unsafe food. Relevant legislation exists including the Drug and Food Control Act, 2012, which provides a legal framework for the regulation of food and drug safety. There are ongoing plans to develop national standards to guide implementation of food safety procedures. South Sudan applies the IDSR system to monitor, identify and investigate food-borne illnesses specifically during food related outbreak of disease. There is significant capacity in the use of IDSR among healthcare workers and public health experts. Operational links between different focal points and sectors are lacking, leaving no formal mechanism for multi-sectoral collaboration and coordination. Food safety related events are not documented, and there is no information-sharing system in place. These are issues that can and should be addressed quickly to improve coordination and food safety. NAPHS-RSS/042 Responsible Budget in US Activity Authority Dollars Objective 1: To develop a National Food Safety Polley and Strategy by end of December 2021 Convene a multi-sectoral stakeholders consultative meeting Ministry of (surveillance, response, food safety, animal health and Agriculture and 4,360 laboratories) with WASH Sector inclusive to form a TWG - one Forestry day 20 participants Ministry of Develop TOR for TWG with clearly define roles and Agriculture and 275 responsibilities - One day meeting Forestry Develop and review annual action plan in collaboration with Ministry of 6950 partners and relevant sectors including WASH - One day Agriculture and meeting - (30 participants) Forestry Ministry of Organize quarterly TWG coord ination meetings - one meeting 4000 Agriculture and per quarter X 4 quarters for 5 years Forestry Ministry of Organize quarterly TWG coordination meetings at State level Agriculture and 4000 (32+1) - one meeting per quarter X 4 quarters for 5 years Forestry Convene a capacity-building workshop for focal points in the various sectors and other relevant stakeholders on prevention Ministry of Health 9800 and response to Food safety/foodborne disease outbreaks for 2 days, 20 participants Ministry of Develop a national check list to monitor food safety events - Agriculture and 160 one day meeting of TWG and partners - 20 participants Forestry Identify food safety focal points in all the 32+1 states and train Ministry of them on the use of the monitoring checklist - (2 staff per Agriculture and 158,100 County x 80 Counties = 160 Participants) - 2 days training (40 Forestry persons per batch in each of the state hubs) Conduct monitoring and registration of food Ministry of premises/slaughterhouses and distribution points in the Livestock and 3,000 Counties on quarterly basis- 2 participants per County Fisheries Ministry of Recruit national consultant to support the development of Agriculture and 7,560 national guidelines on food safety Forestry Organize 2 days Consultative meeting to develop guidelines Ministry of and one day validation meeting (30 participants for each Agriculture and 3,240 meeting) Forestry / NAPHS-RSS/043 ----~ Responsible Budget in US Activity Authority Dollars Ministry of Print 140 copies of the guidelines and distribute to the Counties Agriculture and 14,000 Forestry Ministry of Hire a consultant for 3 months to develop the National Food Agriculture and 40,120 Safety Policy and strategy Forestry Convene two state hubs consultative meetings for Ministry of development of the policy and strategy 2 days for each meeting Agriculture and 30,340 participants including 5 facilitators) - 40 participants for each Forestry Ministry of Conduct Validation meetings (one for the policy and another Agriculture and 1,770 for the strategy ((40 participants - one day each Forestry Ministry of Cabinet Adopt Draft Policy - through parliamentary process - Affairs Ministry of Print and disseminate 1400 copies each of the Policy and Agriculture and 14,000 Strategy on Food Safety Forestry Ministry of Organize high level awareness raising consultative meeting Agriculture and 27,826 with policy makers (breakfast meeting) - 100 participants Forestry Ministry of Hire a national consultant to support the develop IEC/BCC Agriculture and 7,560 materials on Food Safety Forestry Ministry of Field test to validate the IEC/BCC materials - 5 days (10 people Agriculture and 4,280 in 5 locations in the counties) Forestry Ministry of Conduct validation meeting (one day - 40 participants) Agriculture and 1,770 Forestry Ministry of Print and disseminate 5000 of IEC/BCC materials Agriculture and 17,500 Forestry Roll out the policy and plan to stakeholders at the State hubs Ministry of Hold dissemination meetings for 200 participants in each State Agriculture and 98604 Hub/Counties: one day meeting Forestry Develop two Jingles on food safety - Hire consultants for one month Ministry of Agriculture and Forestry 6384 / I/ ----~ NAPHS-RSS/044 Responsible Budget in US Activity Authority Dollars Ministry of Produce and disseminate/airing jingles in all the 10 hubs across Agricu lture and 53200 the Country Forestry Ministry of Produce and disseminate/airing jingles in all the 10 hubs across Agricu lture and 241200 the Country Forestry Ministry of Organize quarterly rad io and television programmes/talk shows Agricu lture and 112000 {state radios & TVs) Forestry Ministry of Organize quarterly rad io and television ta lk shows {at national Agriculture and 0 radio and national TV) Forestry BIOSAFETY AND BIOSECURITY TARGET A whole-of-government national biosafety and biosecurity system with especially dangerous pathogens identified, held, secured and monitored in a minimal number of facilities according to best practices; biological risk management training and educational outreach conducted to promote a shared culture of responsibility, reduce dual-use risks, mitigate biological proliferation and deliberate use threats, and ensure safe transfer of biological agents; and country-specific biosafety and biosecurity legislation, laboratory licensing and pathogen control measures in place as appropriate. South Sudan level of capabilities Capacity in the area of biosafety and biosecurity in South Sudan is generally weak. Currently there is no specific training on biosafety or biosecurity conducted in the country, however Infection Prevention and Control training was conducted in relation to the Ebola preparedness plan. South Sudan does not have biosafety and biosecurity systems for human, animal and agriculture facilities in place and there are no national guidelines or an oversight mechanism in the country. Training on biological risk management is planned to be rolled out in all regions of South Sudan but as yet has not been implemented. The Laboratory Safety Manual, which is still in draft form, is a comprehensive document and its completion would build capacity in this area. NAPHS-RSS/045 Responsible Budget in Activity Authority US Dollars Objective 1: To develop legal framework for biosafety and biosecurity. 1.1 Formation of technical working group (5 members including Ministry of Higher Education, MLF, MoA & MoH); TWG meeting M inistry of Health - of 5 pa rticipants for 2 days to come up with list of pathogens and toxins of security concern 1.2 Select 2 experts to visit human, agricu lture and animal M inistry of Health 1,652 laboratories that handle pathogens 2.1 Hire 2 expert to conduct need assessment for 1 month M inistry of Health 20,440 4.1 Conduct wo rks hop to develop a draft of legal and regulatory framework on Biosafety and biosecurity (25 participants for 5 Ministry of Justice 22,247 days facilitated by 2 experts) 4.2 Validation of draft document by MoJ, MoH, Mo HE MLF and Ministry of Justice 9,460 Agriculture and 30 participants for 2 days NMOH, NMOJ and 4.3 En action of the draft document by the parliament Drugs and food - control 5.1 Identify 5 Mon itoring teams (2 members each) to be dispatch Ministry of Health 40,880 to various states to oversee the implementation prog ress 5.2 Conduct refresher training for 10 participants (Monitoring M inistry of Health 21,747 teams) for 2 days on monitoring tools 3.1 Review existing curricula of selected higher learning institutions and incorporate topics of biosafety and biosecurity M inistry of Health 12,660 for 2 days, 20 pa rti cipants 6.1 Form national and States Task forces (1 representative from each stakeholder) to convene at respective locations twice a Ministry of Health 4,450 month to share informa t ion on biosafety and biosecu rity 6.2 Disseminate shared information to respective decision make rs M inistry of Health 13,920 at higher levels 1.2 Establish on site mentorship for 20 trainees on lab bio safety Ministry of Health 93120 and bio security for 2 weeks per site (Juba, Wau and Malakai) 3.1 Construct and commission 3 regional biobanks M inistry of Health 750000 3.2 Construct a waste area to enhance on site management Ministry of Health biological waste adequately to improve bio safety and bio 84000 security in Juba, Wau and Malakai ,I/ procurements of biohaza rds waste 40liters col or coded bins (Red, M inistry of Health Yellow and Black), waste bags medium, sharp conta iner 28075 disposable, recruit one Bio safety personal each for Juba, Wau and Malakai M inistry of Health 360000 NAPHS-RSS/046 Responsible Budget in Activity Authority US Dollars conduct 3 days specialized training to waste managers on Biohazard waste handling, treatment and final disposal at state Ministry of Health 1431 leve l Enroll the bio safety focal persons on 2 months onl ine bio safety Ministry of Health 0 and bio security training procure 2 kit of bio safety and bio security cold cha in equipment Ministry of Health 54000 per site to enhance specimens storage IMMUNIZATION TARGETS A national vaccine delivery system - with nationwide reach, effective distributions, access for marginalized populations, adequate cold chain and ongoing quality control - that can respond to new disease threats. South Sudan level of capabilities The National EPI programme in South Sudan is responsible for the implementation and management of immunization activities, which is guided by the Comprehensive Multi-Year Plan for Immunization. Despite security challenges, there is a strong commitment towards improving coverage and ensuring access to vaccines. Efforts are ongoing by the govern- ment to expand cold chain management, and these efforts are being supported by Gavi- through the Cold Chain Equipment Optimization Plan. Capacity building for healthcare workers on immunization and provision of critical infrastructure, such as the provision of solar panels and refrigerators to ensure effective cold chain management are an integral part of this plan. The Republic of South Sudan has an established cholera vaccines working group, with cholera vaccines being delivered during humanitarian emergencies and through campaigns to vulnerable populations. This initiative has led to improved protection of vulnerable groups especially the internally displaced persons living in camps. The South Sudanese EPI programme has the buy in of several partners including WHO, UNICEF, CDC, Gavi, Bill and Melinda Gates Foundation, the Health Pooled Fund and IMA World. The government collaborates with these partners to ensure ownership and sustainability of programmes. Despite challenges with routine data collection related to overwhelmed health systems, the government of South Sudan supports periodic surveys and EPI reviews to ascertain the status of immunization in the country. Significant efforts have been made through information and logistics management, to ensure there is no stock out of vaccines at the national level. Still, stock outs do occur at regional levels especially in areas affected by conflicts. NAPHS-RSS/047 Immunization coverage remains low at 34% {Republic of South Sudan EPI and Surveillance Review, September 2017) as the country is faced with challenges of inadequate funds and a high rate of attrition of trained immunization staff due to poor motivation. The presence of difficult terrain and conflicts also means that certain parts of the country are left out for significant periods without vaccines, as resources required like flights to transport vaccines are not readily available. Poor awareness at the community level of the benefits of immunization, remains a major challenge to the EPI programme in South Sudan. However, the coverage for oral polio vaccination is over 70% since the polio national immunization days are well resourced and are conducted 4 times a year nationwide. A mechanism has been put in place to ensure effective vaccine distribution, adequate cold chain and ample human resources are available. Responsible Budget in US Activity Authority Dollars Objective 1: To achieve and sustain at least 90% pentavalent 3 coverage per year 1. conduct mapping of health facilities in all Barnas, by 33 Ministry of Hea lt h 0 teams of 5 persons each (1 team per state) for 10 days 2.Conduct 4 batches of 3-day health facility micro-planning Ministry of Hea lth 6676 tra ining fo r 40 healthcare workers 3. Conduct 2-day health facility micro-planning meeting in 500 Ministry of Hea lt h 323400 health facilities Quarterly review of EPI activities Ministry of Hea lth 57000 5. Engagement of a total of 1,716 volunteers - 500 for fixed sites, 500 for support outreach activities, 216 for mobile teams Ministry of Hea lth 14771808 and 500 for OTP centers. 8. Two days meeting to develop integrated rapid response plan Ministry of Hea lth 9170 for 35 participants 9. Engage 3 rapid response teams (supervisor, d river, Vaccinator, recorder, nutritionist, surveillance officer) for the Ministry of Hea lt h 1696200 33 states. 10. Provide stipends to M&E Officers in 32+1 states for data Ministry of Hea lt h 198000 collation and reporting. 11. County level Monthly 2- Day res idential immunization Ministry of Hea lt h 96000 program review meeting for 25 persons 12. State level Quarterly 3-Day res idential immunization Ministry of Hea lt h 302400 program review meeting for 40 persons 14. 1 Day planning meeting for SIA Ministry of Hea lt h 64400 I/ 15. Conduct 4 rounds of NIDs annually 10400000 1. 1-Day planning meeting for the conduct of needs assessment for effective cold chain management for 40 40800 participants 2. Hire consultant to conduct needs assessment RSS- MoH, SMoH 20440 NAPHS-RSS/048 Responsible Budget in US Activity Authority Dollars 3. Conduct of field work during needs assessment RSS-MoH, SMoH 70080 4. 4 batches of 3 Day residential tra ini ng for 40 program managers and cold chain techn icians at all levels on Min istry of Hea lth 117455 implementing the Cold Chain Optimization and Contingency Plan every year 6. Provide DSA for 5 teams of 3 supervisors per state fo r 33 Min istry of Health 5890500 states and 2 teams of 3 supervisors per county fo r 80 counties. 5. 4 batches of 7-Day residential M iddle Level Tra ining for 40 Min istry of Hea lth 289400 EPI county supervisors every year 6. 25 batches 5-Day Immunization in Practice training for 40 Min istry of Hea lth 2247795 vaccinators every year Objective 2: To strengthen the capacity of District Health Management Teams for improved vaccine access and delivery Conduct 12 batches of 5-Day residential training on supply Min istry of Healt h 197540 chain management for 40 persons annually Conduct 40 batches of 5-day residential training on Monitoring Min istry of Health 57000 and Evaluation for DHMTs and EPI officers Objective 3: Availability of annual vaccination program for at least 5 zoonotic diseases Provide transportation for advocacy visit to stakeholders Min istry of Health 197540 Develop advocacy packs Min istry of Hea lt h 57000 Print advocacy packs Min istry of Hea lth 197540 Refreshments for advocacy meetings Min istry of Hea lth 57000 Engage consu ltant for 3 months to develop Livestock Immunization Progra m including Monitoring & Evaluation M inistry of Healt h 197540 framework 5-Day residential workshop for review of draft LIP plan for 40 Min istry of Health 57000 persons

2 — Day residential workshop to val idate LIP Plan (40

2 Day residential workshop to val idate LIP Plan (40 Min istry of Hea lth 12,700 participants) NAPHS-RSS/049 DETECT NATIONAL LABORATORY SYSTEM TARGET Real-time bio surveillance with a national laboratory system and effective modern point-of-care and laboratory-based diagnostics. South Sudan level of capabilities Laboratory services in South Sudan operate in the Department of Diagnostic Services, which falls under the Directorate of Medical Services. This Directorate is overseen by the MoH, which provides the overarching leadership. There is one NPHL, four laboratories at national teaching hospitals, seven at state hospital level, 17 at county hospital level and 143 at primary health care centers. There is also a veterinary laboratory located in Juba. The main reference laboratory in the country is the NPHL, which can perform tests for five out of 10 core tests, including HIV, TB, malaria, measles and cholera. However, only rapid diagnostic tests for HIV and malaria are available at peripheral facilities and all other testing must be referred to national or international level. For HIV and TB programmes, there are well-defined referral pathways, including MoUs with Kenya and Uganda for international referrals. However, samples for testing for IDSR priority diseases are transported to the NPHL on an ad hoe basis, utilizing NGO vehicles and United Nations Humanitarian Air Service flights as available. Recently a sample transport system using a boda boda (public transport system using motorcycles) has been piloted in Juba. The diagnostic capability at NPHL is affected by frequent reagent stock outs. Capacity to perform classic techniques in microscopy and bacteriology needs development. The NPHL is enrolled in the SLMTA programme and is currently working towards accreditation Responsible Budget in Activity Authority US Dollars Objective 1: To expand lab capacity at the national human and anlmal reference laboratories In selected 1'911onal sites (Wau, Malalcal, Rumbek, and Bentlu) to be able to conduct core tests. Conduct a 5 days' workshop for 33 participants at the nationa l level Ministry of 65626 to review the national action plan Health Conduct two TOT trainings (One human and one animal) for one week for 33 participants to train laboratory focal points in the Ministry of national reference human and animal lab and selected regional sites 49426 Health (Wau, Malakai, Juba) to enable them to process samples for epidemic prone diseases especially cholera cu lture. Ministry of Same above activity (No need for funding) 0 Health NAPHS-RSS/050 Responsible Budget in Activity Authority US Dollars Conduct a workshop to establish the national human and anima l M inistry of laboratory TWG, develop TORs for the TWG; 33 participants and 3 23,675 Hea lth facilitators for 3 days Ministry of Same above activity (No need for funding) - Hea lth Recruit 2 consultant (International & Nationa l) to develop policy and standard for the supply chain and procurement processes (for M inistry of 20,440 acquiring necessary equipment, reagents and consumables) for 3 Hea lth months. SOPS to include both animal health and human health Identify 5 focal persons for lab need assessment at the national M inistry of level and selected sites for both human and animal laboratories 21140 Hea lth (one for each site) Conduct a refresher for influenza and Viral Hemorrhagic Fever - training of staff on sentinel su rveillance for influenza, scale up the M inistry of 2350 train ing to include VHFs and other viruses (PCR machine procu red Hea lth already for South Sudan Conduct a refresher for influenza and Viral Hemorrhagic Fever - training of staff on sentinel su rveillance for influenza, scale up t he M inist ry of 300000 training to include VHFs and other viruses (PCR machine procu red Hea lth already for South Sudan Procurement of standardized equipment for NPHL, WAU, Mala kai M inistry of and Juba Teaching Hospitals (3 Teaching hospital laboratories and 1 240000 Hea lth National Public Health Laboratory) Procurement of standardized reagents for NPHL, WAU, Malaka i and M inistry of Juba Teaching Hospitals (3 Teaching hospital laboratories and 1 50000 Hea lth National Public Health Laboratory) Procurement of culture media and reagents (antisera, biochemical M inistry of 60000 test) for the laboratories at the selected sites; conduct train ings on Hea lth culture at the selected sites Construct laboratories with capacities to conduct bacteriologica l M inistry of 750000 testing and microbiological culturing in Wau; Malakai; and Yambio Hea lth Procurement of standardized reagents for NPHL, WAU, Malakai and Ministry of Juba Teaching Hospitals (3 Teaching hospital laboratories and 1 Hea lth 140000 National Publ ic Health Laboratory) Objective 3: To Institute an effective system for collection, packqln1 and transport of bloloalcal specimens Formation of technical working group (5 members including MoH/MLF/other Ministry MLF, MoE, MoA & MoH) with agreed TOR to guide the 0 relevant sectors implementation of specimen referral system NAPHS-RSS/051 Responsible Budget in Activity Authority US Dollars Recruit a consultant to do mapping of the laboratory referra l system at all relevant sectors (Human and an imal labs) across the country MoH/MLF/other 0 for 30 days, followed by a lab networking meeting at the national relevant sectors level with all the laboratory stakeholders (33 pa rticipants) Hire 1 international consultant to develop a national guideline to Ministry of regulate the appropriate packaging and referral system for a period 40880 Health of one month Hire 1 local consultant to develop a national guideline to regulate Ministry of the appropriate packaging and referral system for a period of one 9120 Health month Conduct five days' workshop to review and finalize the national guideline, SOPs and monitoring tools to regulate the appropriate Ministry of 28480 packaging and referral system (18 participants for 5 days faci litated Health by 2 experts) Conduct two days validat ion workshop for the national guidel ine, SOPs and monitoring tools to regulate the appropriate packaging Ministry of 8976 and referral system (18 partic ipants for 2 days facilitated by 2 Health experts) Printing of National Guidelines, SOPs, M&E tools, each document, Ministry of 3,5USD/ copy, SOP 500 copies @1,20USD/copy, Job aids posters 5400 Health

500 — A3 size copies@ 3,5 USO/copy

500 A3 size copies@ 3,5 USO/copy Conduct five days TOT training for the state Lab focal point at the Ministry of 28746 national level for 33 partic ipants and 2 experts Health Conduct 7 days on-site cascade training in 10 hubs each with 10 Ministry of 350500 participants Health Sign agreement with a courier companies (publ ic or private) for MoH/MLF/other 0 specimen transportation from at least 85% of health facilities relevant sectors Shipment from specimens from peripheral facilities to Regional and Ministry of National Levels. Each package cost 25USD/per facility per week 1950000 Health from 300 facilities Conduct a training for international laboratory focal point for both Ministry of Human and animal health at the national level as per IATA Health 0 stand ards for 33 part icipants for 5 days Procure courier services for national and international shipment of Ministry of 600000 biologica l samples collected in South Sudan Health Objective 4: To develop or acquire technolCJlles to optimize POCT at all levels (human and anlmal health) / ----~ NAPHS-RSS/052 Responsible Budget in Activity Authority US Dollars One day meeting to form the POCT technical working group (5 Ministry of members including Ministry MLF, & MOH) with agreed upon TORs 6640 Health to guide the implementation of POCT Hire 1 international and 1 local consultant to develop a POCT Ministry of 20440 nationa l guideline, SOPs and M&E tools for 30days Health Conduct five days' workshop to review and finalize the national Ministry of guideline, SOPs and monitoring tools for POCT (10 participants for 5 17800 Health days facilitated by 2 experts) Conduct two days validation workshop for the national guideline, Ministry of SOPs and monitoring tools for POCT implementation (10 3704 Health participants for 2 days facilitated by 2 experts) Ministry of Printing of National Guidelines, SOPs, M&E tools. 4200 Health Five days dissemination workshop for national guidelines (specimen Ministry of referral, POCT and others relevant) for 33 participants and 2 46926 Health nationa l consultants Recruit 2 consu ltants (International & National) to establ ish the MoH/MLF/other 0 supply management system for point of use diagnostics for 1 month relevant sectors Recruit 2 consu ltant (International & National) to develop an MoH/MLF/other integrated syndromic and laboratory- based POCT algorithm for one 0 relevant sectors month Objective 5: Institute and operatlonallzed a national quality assurance system for human, anlmal, environment and food safety Including national human and anlmal laboratory Regulatory Board Conduct a 5 days' workshop for 33 participants to establish a National Accreditation Board for Testing & Calibration Laboratories Ministry of (NABL) unit for qua lity assurance system for human, animal, 130686 Health environment and food safety. With 2 international facilitators from accred ited labs and 4 national facil itators MoH/MLF/other Same above activity (No need for funding) 0 relevant sectors Conduct tra ining on the key elements of documentation, such as document format, authorization of document, issue and w ithdrawa l Ministry of 47926 procedures, document review and change, at the national and state Health level for 5 days, for 33 participants Train the NABL staff after estab lishing the board on NABL standards and procedure, etc. Each document should have ID No., name of Ministry of 47326 controlling authority, period of retention, etc. fo r 33 participants for Health 5 days / ----~ NAPHS-RSS/053 Responsible Budget in Activity Authority US Dollars Hire 1 international consultant to develop to prepare QUALITY Ministry of 52456 MANUAL as per ISO 15189 standards. Health Conduct a workshop to review and update laboratory standa rd Ministry of 0 Operating Procedure for 5 days, for 33 participants Health Conduct a workshop to prepare QUALITY MANUAL as per ISO 15189 Ministry of 26228 standards for 7 days for 33 participants Health Identify regional/international standard reference laboratories for MoH/MLF/other 0 qua lity control relevant sectors Recruit 2 consultants (International and national) for 30 days to establ ish standard laboratory infrastructure (Bu ilding, Equipment's, Ministry of Biosafety units, Sample collection and transfer units, data collection 40880 Health tools and commun ication materials at the national human and animal laboratories and selected regional sites Hire one International and one national biomedical engineer to Ministry of calibrate instruments/ equipment as per the NABL ACCREDITED 40880 Health CALIBRATION standards for 30 days Train 4 national biomedical engineer to calibrate instruments/ MoH/MLF/other equipment as per the NABL ACCREDITED CALIBRATION standards 0 relevant sectors for 6 months Recruit 4 quality manager (Human, Animal, Food, Environment) to establ ish standard internal quality control to ascertain the status of Ministry of 828000 the existing quality system and technical competence about NABL Health standards Recruitment of 3 biometric engineers for the national human and Ministry of animal reference lab and selected regional sites (Wau, Malaka i, 20440 Health Juba) Conduct 5 days' workshop for 33 participants both national and Ministry of state, with 2 international and 4 national facil itators to develop 27305 Health SOPs on the use of laboratory information management systems Recruit 2 consu ltants (International & National) to develop and rollout a laboratory information management system to integrate Ministry of 40880 laboratory data from all relevant sectors, need to buy the relevant Health software Bring the accreditations auditors from South Africa for one month Ministry of 40880 to support facilities already enrolled in SLMTA to get accredited Health Objedlve 6: Establish a comprehensive legal and regulatory framework to dlred and monitor the delivery of safe, quallty laboratory services at all levels of the tier health laboratory system ----~ NAPHS-RSS/054 Responsible Budget in Activity Authority US Dollars Hire one international consu ltant to support establishment of Ministry of laboratory council and Association guidelines and checklist 20440 Health laboratory services quality hand standard inspection for 30 days MoH/MLF/other Same above activity (No need for funding) 0 relevant sectors Hire one consu ltant to support develop online platform for Ministry of 20440 registration of laboratories and personnel for 30 working months Health Hire one consu ltant to support estab lishment of laboratory council MoH/MLF/other 0 and Association for 30 days relevant sectors Conduct quarterly inspections of Laboratory se rvices by a multi- Ministry of 77600 disciplinary team of 10 members Health NAPHS-RSS/055 REAL TIME SURVEILLANCE TARGET Strengthened foundational indicator- and event-based surveillance systems that can detect events of significance for public health, animal health and health security; improved communication and collaboration across sectors and between sub-national, national and international levels of authority regarding surveillance of events of public health significance; improved country and intermediate level regional capacity to analyze and link data from and between strengthened, real-time surveillance systems, including interoperable, interconnected electronic reporting systems. This system would include epidemiologic, clinical, laboratory, environmental testing, product safety and quality and bioinformatics data; and advancement in fulfilling the core capacity requirements for surveillance per the IHR and OIE standards. South Sudan level of capabilities The IDSR strategy has been implemented and is functional, with trained healthcare workers at 80% of the functional health facilities. Further, IDSR and epidemiological bulletins and cholera outbreak situation reports are produced weekly and shared with stakeholders. The country has identified 26 priority diseases for surveillance purposes, where IBS and EBS systems are functional and coordinated under the IDSR strategy. Syndromic surveillance is also conducted, under IDSR for several diseases and conditions including Acute Flaccid Paralysis, Acute Respiratory Illness, VHF, Acute Jaundice Syndrome, Acute Bloody Diarrhea, Acute Watery Diarrhea. The Early Warning Alert and Response Network (EWARN) is operational in areas with high internally displaced persons (IDPs). Indicator based surveillance (IBS) on 14 epidemic-prone diseases is performed in health facilities and reporting is done weekly. Event based surveillance (EBS) is being conducted but currently collects information on events reported through the formal reporting system. The current EBS systems should be expanded to integrate events from the infor- mal reporting channels. The recently introduced Boma Health Initiative will enhance community-based surveillance and reporting. Data analysis is mainly performed at the national and state levels while capacity is limited at lower levels of the health system. Two platforms are used for reporting and data analysis District Health Information Software (DHIS) 1.4 and Early Warning, Alert and Response System (EWARS), however these applications are not interoperable. Both papers based and electronic data reporting are in place based on the level of health system and reporting forms capture surveillance, outbreak, and laboratory information. NAPHS-RSS/056 Responsible Budget in Activity Authority US Dollars Objective 1: lntepate and sustained anlmal and human health real time surveillance systems IDSR revised strategy ToT at national level (SSO & EPR team), 40 participants for 5 days. This ToT is to be based on the 3rd Ed it ion of Ministry of 11,500 the IDSR technical guidelines and cascading it thereafter to lower Health levels. Train 32+1 state surveillance officers on IDSR strategy for 5 days Ministry of (Modules on EWARS Reporting and EWARN components to be 29,168 Health incorporated into the trainings) Train 80 county surveillance officers on IDSR strategy for 5 days Ministry of (Modules on EWARS Reporting and EWARN components to be 38500 Health incorporated into the trainings) Train 1700 health workers at facility level, on IDSR strategy for 5 Ministry of days (Modu les on EWARS Reporting and EWARN components to be 56100 Health incorporated into the tra inings) Ministry of Print and distribute IDSR tools and guidelines in all health facilities 25000 Health Conduct quarterly supportive supervisory visits by national level to Ministry of 311280 the state level Health Conduct monthly supportive supervisory visits by State level to the Ministry of 311280 county level Health Conduct monthly supportive supervisory visits by county level to Ministry of 29440 the health facilities Health Ministry of Conduct annual review meetings at National level facility 94910 Health conduct re-fresher training for32+1 (66) state (SSO & M&E) IDSR Ministry of 113188 data managers at national leve l by nationa l faci litators for 5 days Health Recruit an international consultant; to support the development of Ministry of SOP and train staffs on human and animal EBS/EWARS for one 20440 Health month Conduct stakeholder engagement and validation meeting (MoH, Ministry of MLF, Wildlife Tourism and Conservation and relevant partners) for 24600 Health 3 days at national level for 30 participants Review and validate the SOP on human and animal EBS after one Ministry of 3380 year of implementation for 2 days for 30 participants Health Print and distribute SOPs on human and animal EBS on EWARS & Ministry of 20000 / DHIS2 Health Conduct dissemination workshop on SOPs, guidelines and tools on Ministry of animal and human EBS on EWARS and DHIS2 for two days for 40 19490 Health participants ... ----~ NAPHS-RSS/057 Responsible Budget in Activity Authority US Dollars Train state surveillance officers (32+1 from MoH, 32+1 from MLF) M inistry of on human and animal EBS (EWARS&DHIS2) for 3 days for 70 23740 Health participants Train county surveillance officers (80 from MoH, 80 from MLF) on M inistry of 47480 human and animal EBS (EWARS &DHIS2) for 3 days Health Conduct cross border meeting for Surveillance Officers from MoH M inistry of and MLF of neighboring countries for 3 days after every 6 months 62020 Health for 60 participants Establish 7 disease surveillance cross border human and animal M inistry of surveillance at Nimule, Yei, Kapoeta, Renk, Wudkona, Aweil, Twic Transport - (Civil 56000 and 1 screening posts at international airports (Malakai) ltent, - Aviation) prefab setup, running costs - consumables Establish 4 hotline communication system for human and animal M inistry of 60000 surveillance (Livestock & Health) Health Share cross border surveillance data between neighboring M inistry of 0 countries Health Establish a mechanism for information sharing between the sectors M inistry of quarterly between human and animal sectors. Develop SOPs 3,380 Health through multisectoral meetings Recru it a consultant to evaluate the surveillance system for 30 days M inistry of 20,440 (a month) Health Objective 2: Develop, Integrate and maintain an Interoperable, Interconnected, electronic real-time reporting system, for publlc health and/or veterinary surveillance systems at all levels Develop a common database for the ministries of hea lth, Livestock M inistry of 20,440 and Fisheries by international consultant for one month Health Re-assign a designated data manager for the common database fo r M inistry of - the ministries of health, Livestock and Fisheries Health Train 20 national data managers on the use of the common M inistry of database for the ministries of health, Livestock and Fisheries for 5 17250 Health days after every 2 years M inistry of Recruit a consultant to support upgrading DHIS 1 to DHIS 2 20440 Health Train data managers (national= 10, State =32+1,) on DHIS 2 for 5 M inistry of 32668 days Health M inistry of Train data managers (80 counties) on DHIS 2 for 5 days 20500 / Health using the existing electronic report ing platform (EWARS and DHIS2) M inistry of to strengthen real-time reporting by buying airtime, bundles, on 60000 Health the job trainings and replacement of the lost electronics. ,,, ----~ NAPHS-RSS/058 Responsible Budget in Activity Authority US Dollars Tra ining of surveillance and M&E officers in electronic reporting for M inistry of 30750 5 days Health Objective 3: Stren1then capacity for data analysis at all levels by 2022 Train data managers (national= 20, on data analysis surveillance M inistry of 21000 system (National TOT) Health Tra in data managers - State =66 on data analysis surveillance M inistry of 86750 system Health Tra in data managers County =160 on data analysis surveillance M inistry of 131900 system Health Procure computers for data managers (nationa l= 20, State =64, M inistry of 49500 County =160) Health Objective 4: Enhance the perfonnance of the syndromic surveillance system and expertise Nationwide assessment/survey of syndromic surveillance system M inistry of 1103520 (county level ) Health Tra ining/refresher training for (national= 20, State =64, M inistry of 183432 surveillance officers in surveil lance of critica l syndromes Health Training/refresher training for County =160) surveillance officers in M inistry of 115500 surveillance of critical syndromes Health Quarterly coordination meetings between zoonotic and human M inistry of 26200 surveillance techn ica l working groups for 20 people for 2 days Health Quarterly joint supportive supervision visits under 1 health (MOH , M inistry of 572520 MLF} from national staff at the County level Health Community and event-based surveillance to be aligned to the BHI. M inistry of A 5-day training on EBS/BHI ta rgeting all Barnas from two high risks 31418 Hea lth counties from all 10 former states. Community and event-based surveillance to be aligned to the BHI. M inistry of A 5-day training on EBS/BHI ta rgeting all Barnas from two high risks 31418 Health counties from all 10 former states. NAPHS-RSS/059 REPORTING TARGET Timely and accurate disease reporting according to WHO requirements and consistent coordination with FAQ and OIE. South Sudan Level of Capabilities Currently the country is using the reporting mechanism prescribed in the IDSR technical guidelines for internal reporting from the community/facility level up to the national level, and IHR annex 2 for the NFP reporting to WHO. However, South Sudan needs to ensure the national system is fully developed to guide reporting to WHO, FAO, and OIE. Further, South Sudan should embark on training more people to report potential PHEICs to WHO and OIE World Animal Health Information System (WAHIS). The National IHR focal point and OIE delegate are in place but there is no mechanism for sharing information. The NFPs should also have tool kits with best practices, model procedures, reporting templates, and training materials to facilitate rapid (within 24 hours) notification of potential PHEICs. The IHR NFP is the directorate of International Health and Coordination in the MOH and there is an OIE delegate at the Ministry of Livestock and Fisheries. The OIE delegate was trained on the roles and responsibilities of WAHIS, data management and reporting. There is an MoU between the South Sudan Ministry of Livestock and Fisheries and the Ministry of Agriculture and Animal Industry and Fisheries of Uganda. Activity Responsible Budget Authority in US Dollars Objective 1: Strencthen capacity to Identify any potentlal PHEIC and report within 24 houn to WHO, FAO and OIE Identify and orient IHR Focal Points in relevant government institutions/Partners (MoH, MoJ, MHADM, MoCA, MLF, MoP, MoE, WHO, Min istry of 3746 FAO,OIE) for IHR membership to coordinate and monitor the IHR activities Hea lth implementation for 15 people for Two day. Min istry of Organizing a bi-annual review meeting for the IHR committee 353960 Hea lth Restructuring of the national MOH to create a position for the director of IHR Min istry of 0 under the directorate of international health and coordination. Health Create office space accessories and provide ICT equipment for the Min istry of 16800 designated focal points of IHR in all relevant sectors Hea lth Min istry of Train national IHR focal point team on IHR report ing (15ppl x 3 days) 3384 Health NAPHS-RSS/060 Activity Responsible Budget Authority in US Dollars Ministry of Conduct biannual simulation/TIX exercise on IHR reporting (34pp l x 2 days) 41300 Health Develop, print and disseminate guidelines and protocols on different sectors Ministry of 8892 specif ic protocols Health Provisions for ad hoe meetings of the IHR community to review PHEIC aga inst Ministry of 408280 the Decision Instrument (On needs basis) Health Objective 2: Develop and establlsh protocols, processes, replatlons and lealslatlon 1CJVeml111 reportl111 of potential publlc health erneqencles of national and lntematlonal concern and zoonotlc events Sensitize the stakeholder on different sectors specific protoco ls, regulations Ministry of and legislations and reporting guidelines (60 ppl x 5 days) to agree on how to 42540 Health share information across sectors Train IHR Focal Points from (MoH, MoJ, MHADM, MoCA, MLF, MoP, MoE, Min istry of WHO, FOA, OIE) on protocols, regulations and legislations and reporting 42540 Health guidelines (60 ppl x 5 days) Train national IHR focal point and the State Surveillance Officers, Vet officers Ministry of 38926 on IHR intermediate/ level reporting (34ppl x 3 days) Health Annual refresher trainings for IHR intermediate level reporting (34 ppl x 3 Ministry of 155704 days) Health WORKFORCE DEVELOPMENT TARGET States Parties with skilled and competent health personnel for sustainable and func- tional public health surveillance and response at all levels of the health system and the effective implementation of the IHR (2005). South Sudan level of capabilities The health workforce capacity of South Sudan is quite low at all the levels in terms of numbers and skill mix of the requisite human resource. The MoH human resource database does not include information on core IHR personnel such as epidemiolo- gists. There is a national human resource development strategy, but it does not cover public health professionals. Available data indicates that there are 18 field epidemiologists (eight at national level and 1Oat sub-national level) that support disease outbreak investigations. The MoH has no establishment for epidemiologists, and as such most of the available epidemi- ologists are employed in the NGO/UN sectors. No mechanism is in place to track field epidemiology capacity, and staff attrition is high. NAPHS-RSS/061 The situation regarding biostatisticians and laboratory scientists is similar as well as with animal health experts, veterinarians, and farming/ livestock professionals. Capacity of local training institutions to produce the quality of human resource to meet effective IHR implementation is also low. An initiative to train surveillance officers in field epidemiology with support from US Centre for Disease Control and prevention {CDC) was terminated in 2013. Three public universities are offering medical training and two universi- ties that produce public health officers. Some institutions that train nurses, laboratory assistants and animal/livestock professionals exit. Actions Responsible Budget in Authority US Dollars Objective 1: Establish a Multldlsclpllnary Publlc Health HR capacity at National and county levels by 2022 A one-day consultative meeting with the relevant line ministries and Ministry of stakeholders to agree on the need for a comprehensive human 320 Health resou rce assessment and mapping (20 PAX for 1 day) Recruit 1 international consultant to support the comprehensive HR assessment and mapping of country Human Resource capacity for IHR Ministry of implementation. The mapping will be done to provide a database of Health 14,160 HR and will also inform in the needed capacity or gaps. Recruit 2 national consultants to conduct the comprehensive HR assessment and mapping of country Human Resource capacity for IHR Ministry of implementation fo r 6 months. The mapping to provide a database of Health 9,120 HR and will also inform in the needed capacity or gaps. A one-day meeting with stakeholders to validate the assessment and Ministry of mapping results to update the national human resource strategy to Health 1,300 include relevant Public Health workforce Based on the mapping and assessment review, hire a consultant for 1 month to develop a program that will support deve lop ing a Ministry of Continuous Professional Development (CPD) plan of the health Health 14,788 workforce and review the accreditation process of institutions that produce the health work force Advocacy for public health HRH strategy to include specialty areas in line with One Health approach. A two days meeting where a Joint Ministry of position paper of the line ministries to advocate for the One Health Health 1,460 Strategy to be presented to senior management of the relevant ministries. Quarterly stakeholders' meetings to monitor implementations of the Ministry of 2560 / public health HRH strategy th rough the line ministries. Health / ----~ NAPHS-RSS/062 Actions Responsible Budget in Authority US Dollars Conduct joint quarterly supportive supervision and monitoring visits M in istry of implementations of the public health HRH strategy through the line 71200 Health ministries. Two days meeting of stakeholders to review the HR Staffing Norms to M in istry of determine the requ ired cadres for public health security for all Health 1,530 relevant sectors (20 pplx3) Organ ize stakeholders and donors engagement workshop for 20x2 M inistry of days to develop concept and mobilize resources to re-establish Field Health 1,960 Epidem iology tra ining program (FETP )in South Sudan. Half day meeting for stakeholders and key donors at MOH meeting Min istry of hall at no cost Health - RESPOND PREPAREDNESS TARGET Development and maintenance of national, intermediate (district) and local/primary level public health emergency response plans for relevant biological, chemical, radiological and nuclear hazards. This area covers mapping of potential hazards, identification and maintenance of available resources, including national stockpiles and the capacity to support operations at the intermediate and local/primary levels during a public health emergency. South Sudan level of capabilities The country carried out a national risk assessment in July 2017 and classified diseases and other hazards into four groups: high, moderate, low and very low. An all hazard national emergency preparedness and response plan is yet to be developed, however, some disease specific response plans have been developed (i.e. Ebola Virus Disease, malaria, measles, cholera, hepatitis E and meningitis). The country is yet to carry out a comprehensive resource mapping in line with the identified risks and hazards. A plan is in place to create a directory of the RRTs and relevant human resources, determine the capacities of the different health facilities, map the capabilities, available partners, and decide on locations to stockpile key logistics. Though RRTs have been constituted at the national, state and county levels, there is limited information on their current availability due to a high attrition rate in the country. Simulation exercises to assess the operational readiness of the National RRT to respond to disease outbreaks NAPHS-RSS/063 was undertaken in 2015 in readiness for the Ebola virus outbreak that was ravaging several counties in West Africa at the time. Generally, the available emergency response materials and the capacity for logistics management are partner or donor driven. Responsible Budget in Activity Authority US Dollars Objective 1:To map the risk, develop and test costed multi-hazard NPHEPR plan based on VRAM findings by 2020 -2022 Review and update the Risk profiling for the Country using the Ministry of Health 16900 STAR Tool Hire international consultant to support VRAM Ministry of Health 33060 Conduct the VRAM workshop - done Ministry of Health 0 Orientation on the use VRAM exercise Ministry of Health 7260 Conduct a pilot on the data collection tools in 1 County Ministry of Health 2340 Conduct a pilot on the data collection tools in 1 County Ministry of Health 2000 Training of trainers at national level for VRAM Ministry of Health 4566 Purchase of mobile phones for VRAM data collection Ministry of Health 7000 Field data collection in former 80 Counties. Ministry of Health 54744 Hire consultant to Conduct VRAM data analysis for 1 month, P3. Ministry of Health 61320 Hire data clerk to Conduct VRAM data entry for 1 month. Ministry of Health 4500 Conduct simulation exercises for 40 participants to test the plan (stationaries for the exercises, logistics support, DSA, Internet Ministry of Health 11520 access) One day meeting to Validate the updated plan to be approved Ministry of Health 5520 by MOH leadership. Printing of 20 copies of the updated plan for the validation Ministry of Health 900 meeting to be approve by the MOH Objective 2: To Implement the costed multl-hazard NPHEPR plan Launching of the NPHEPR Plan Ministry of Health 1,575 Printing of the NPHEPR Plan Ministry of Health 3,000 Train the stakeholders to use the plan at all levels (ToT training) Ministry of Health 3580 at National level for 30pax. 3 days meeting for After Action Review (AAR) following the EOC Ministry of Health 14760 activation for 30pax. Hire international consultant for one month to write the AAR Ministry of Health 61320 Report Objective 3· To map Publlc Health risks NAPHS-RSS/064 Responsible Budget in Activity Authority US Dollars 2 days' Workshop to develop resource mapping checklist for Ministry of Health 3,380 20pax. 3 days for validation and piloting the resource mapping tool in 2 Ministry of Health 1836 counties. Hire consultant to Analyze the data and Update the checklist Ministry of Health 2280 based on the field find ing. Ana lyze data and develop strategic plan (consultant for 1 Ministry of Health 20440 month, P3. validate and launch the strategic plan for resou rces Ministry of Health 4230 mobilization Objective 4: To utlllze the Publlc Health resources Quarterly review meeting at national level for 20pax. Ministry of Finance 132200 Two Days Annual Meeting with Donors on resou rce Ministry of Finance 13100 mobilization Field level coordination meetings quarterly, all partners, Ministry of Finance 42400 stakeholders', venue, statione ry, refreshments) 2 days every four months national level coordination meetings Ministry of Health 98700 fo r all partners and stakeholde rs. EMERGENCY RESPONSE OPERATIONS TARGET Country with public health emergency operations center (EOC) functioning according to minimum common standards; maintaining trained, functioning, multisectoral rapid response teams and "real-time" bio surveillance laboratory networks and information systems; as well as trained EOC staff capable of activating a coordinated emergency response within 120 minutes of the identification of a public health emergency. South Sudan level of capabilities The South Sudan Emergency Operations Centre (EOC) is currently under construction and is situated within the NPHL in the Public Health Directorate. Multi-sectoral RRTs are in the process of being set up but with the EOC still under construction, only a virtual EOC system is currently in place. This system operates for eight hours daily, although personal contact details including phone numbers are made available and team members respond to emergencies at any time of the day. There is an established coordination mechanism, with an EOC focal person that can sup- port and convene partners at short notice. South Sudan has case management guidelines for the epidemic prone diseases, and there is continuous capacity building for identified ad hoe EOC personnel. The ad hoe EOC personnel NAPHS-RSS/065 are drawn from different sectors including the ministries of health, agriculture, environment, animal resources, water and irrigation as well as security agencies. Capacity gaps exist among ad hoe EOC team members in the areas of information sharing, public communication and coordination. There are no training, exercise or activation plans for emergency response. Resources including funds and emergency supplies are inadequate, with some areas being inaccessible due to insecurity and geophysical factors. Responsible Budget in US Activity Authority Dollars Objective 1: To enhance capacity to activate emergency operations Maintain the existing four teams (2 for VHF and 2 for other - Ministry of Health emergency events) of Nationa l Rapid Response Team Support the existing four teams (2 for VHF and 2 for other 840,000 Ministry of Finance emergency events) of national rapid response team Conduct TOT for the National Rapid Response Teams to 51,510 cascade the training to the 32+1 State level (4 teams the Ministry of Health comprised of 7 members each) . Conduct RRT Tra ining for the 32+1 states to cascade it to the 363,858 Ministry of Health lower levels. Equip RRT with PPEs, visibility items, patient examination 495,000 Ministry of Health equipment. Support the existing staff as per EOC structure & IMS (PHEOC 1,320,000 Manager, Deputy manager, 3 Section heads and 3 Alternates i.e. Operations, Planning, Logistics, and Adm in & Finance, and 8 Ministry of Fi nance support staff (4 cleaners, 2 guards,1 generator operator, 1 messengers) under the government payroll Comprehensive TOT tra ining for EOC staff on general and 32,200 specific IMS technical areas (5 days trainings each for, 28pax, 2 Ministry of Health facil itators) Conduct Simulation exercise (Tabletop exercise, Drills for 7,260 National Rapid Response, Full exercise) Simulation exercises for Ministry of Fi nance all staff (P lans, Stationaries, Facilitators, Mobil ity, supplies for t he exercises) Objective 2· To have a fully functional EOC operating as per WHO standards Expanding the current EOC build ing (add second floor, three M inistry of stories for and perimeter wall with security wiring and light+ 400,000 Infrastructures CCTV cameras) Backup generator (S0kva, maintenance) + Connecting the EOC Ministry of Health 17,000 I wit h the city power extension ----~ NAPHS-RSS/066 Responsible Budget in US Activity Authority Dollars monthly maintenance of the generator Ministry of Health 60,000 Solar backup system (20 panels, 20 batteries of 120watts) Ministry of Finance 50,000 IT equ ipment (server, 500 GB internet bundles per month, 4 27,850 monitors, 15 desktop computers, 4 laptop computers, 4 LCD Projector, 1Sound system, 25 antivirus,10 Power extention,1 Ministry of Finance TV Screen,1 IT Monitor Device,1 printer 3 in one,3 small printers, ,10 la nd phones, 20 mobile phones, 5 Satellite phones to communicate in hard to reach are as) IT equ ipment (server, 500 GB internet bundles per month, 4 22,100 monitors, 15 desktop compute rs, 4 laptop computers, 4 LCD Projector, 1Sound system, 25 antivirus,10 Power extention,1 Ministry of Finance TV Screen,1 IT Monitor Device,1 printer 3 in one,3 small printers, ,10 la nd phones, 20 mobile phones, 5 Satellite phones to communicate in hard to reach areas) Vehicles (1 land cruiser 5-doors, 2 pick-u ps,2 ambulance, 1 210,000 Minibus for staffs,4 high speed motor bikes, maintenance, Ministry of Fin ance spare part and fuel) Veh icles (2 land cruisers 5-doors, 2 pick-ups,2 ambulance, 1 390,000 Minibus for staffs,4 high speed motor bikes, maintenance, Ministry of Finance spare part and fuel) Furniture (2 meeting tables, 5 office tables, 20 office cha ir, 10 24,200 office desk, 5 office cabinets, 50 small meeting chairs, 2 Ministry of Finance refrige rator 8-10 feet) Administrative Cost M inistry of Health 18,000 Review and update the handbook for PHEOC and incorporate - M inistry of Health some SOPs. Develop and val idate the legal framework for PHEOC 20,440 (consultant fee, legal advisor fee, draft the document and Ministry of Justice present it for endorsement) validate the legal framework for PHEOC (consu ltant fee, lega l advisor fee, draft the document and present it for Ministry of Justice 3,180 endorsement) Printing of200 copies of PH EOC handbook for dissemination to 12,400 M inistry of Health all the three levels (n ational,33 states and 80 Counties). Develop emergency respond plan fo r PHEOC activation, 20,440 M inistry of Health validate and launch (Consultant for lmonths) Top table exercise for the PHEOC response plan M inistry of Health 1,480 Train the State level staff on PHEOC handbook to strengthen 22,552 M inistry of Health the coordination ./ .,,.....,. NAPHS-RSS/067 Responsible Budget in US Activity Authority Dollars Objective 3: By 2022, all the emersencles manapd within the EOC framework (One Health approach) Apply EOC coordination structure and IMS Ministry of Health - Weekly EOC management meetings Ministry of Health - Weekly EPR meetings Ministry of Health - Dissemination of the information products Weekly epidemiologica l bulletin, SPOTREP, SITREP, Ad hoe Ministry of Health 52,000 communication (Contacts database, mai ling groups, regular Internet and power supply, on standby trained staff) Weekly taskforce & TWG meetings for emergency Ministry of Health - Conduct annua l After-Action Review for ana lysis and 190,800 Ministry of Health emergency Recruit 4 watch officer in the PHEOC Call Center to manage and 96,000 Ministry of Finance monitor the hotline. Operation costs for the PHEOC Call center Ministry of Health 46,080 Ministry of 10,000 Developing PHEOC website and domain hosting. telecommunication and post services Media monitoring (Internet search and purchase of daily Ministry of 10,800 newspapers) Information Conduct quarterly supportive supervision to 32+1 states by 196,400 Ministry of Health nationa l teams. Allocate Emergency fund for outbreak investigation Ministry of Health 25,000 Objective 4: To ensure that by 2022, all lHR relevant hazards manapd as per standard WHO case manapment procedures Recruit international for 1 month Ministry of Finance 20,440 Validation workshop Ministry of Finance 33,711 Conduct workshops on standa rd case management guideline M inistry of Health 23,420 for al l relevant hazards Train relevant staff from implementing authorities on case M inistry of Finance 8,750 management guidelines for relevant Hazards. Review and Update the guideline to address gaps identified Ministry of Finance 3,830 during implementation . Printing of the first edition and the second revised edition of Ministry of Health 12,500 the case management guideline for relevant hazards. Launch report Ministry of Health 320 Distribute report to 32+1 states (transport cost) - Conduct workshops on outbreak investigation and report Ministry of Health 18,550 writing at national level )/ NAPHS-RSS/068 Responsible Budget in US Activity Authority Dollars Establish permanent infectious disease isolation wards/ Ministry of Health 750,000 facilities in at least three high risk locations of Yei River state; Gbudue state; and Torit state LINKING PUBLIC HEALTH AND SECURITY AUTHORITIES TARGET Country conducts a rapid, multisectoral response in case of a biological event of suspected or confirmed deliberate origin, including the capacity to link public health and law enforcement, and to provide and/or request effective and timely international assistance, such as to investigate alleged use events. South Sudan level of capabilities South Sudan has very limited functional links between public health and security authorities. More effort is needed to raise the capabilities in this technical area for this new ountry to effectively implement the IHR in this technical area. There is very little awareness by some security personnel of their role in coordinating with public health authorities. The JEE team has realized that some security authorities have their health committee which is not linked to the Ministry of Health. As this report is assembled, there is no signed protocol, MoU, or any written agreement linking public health to the security forces. No joint exercises nor simulations by public health and security authorities linked to biological and toxins events have been done. The scarcity of resources hinders the improvement of the country's capability. However, a joint training exercise was done with the medical corps of the national army for IDSR training. The medical corps from the national army have participated in cholera taskforce meetings. The cholera taskforce has provided training and logistical support to the medical corps to facilitate cholera and Ebola Virus Disease prevention and control in military locations. Additionally, there was representation from other relevant government ministries in cholera and Ebola Virus Disease epidemic taskforce. Security agencies and other bodies informally share information of any suspected diseases outbreaks with the MOH. Responsible Budget in US Activity I/ Authority Dollars Objective : To have coordinated Joint response operations to blologlcal events SSPDF- (Defense Recruit consultant P3, 2 months Health Services) 9,120 / NAPHS-RSS/069 Responsible Budget in US Activity Authority Dollars Validation workshop with stakeholders (20pax, 3 days, SSPDF- (Defense 3,896 breakfast, lunch, stationary, transport, venue) Hea lth Services) formation of joint committee to oversee the linkage of PH SSPDF- (Defense 0 and Security interventions Hea lth Services) Two days training of data collectors (66 pax, venue tea break SSPDF- (Defense 65,448 stationaries, Lunch, DSA Transport refund Hea lth Services) SSPDF- (Defense Joint data col lection from 32+1 states 57,600 Hea lth Services) SSPDF- (Defense Data analysis (to be done by consultant) 0 Hea lth Services) SSPDF- (Defense Develop joint response plan using the findings 0 Hea lth Services) SSPDF- (Defense Two-day val idation Workshop 2,420 Hea lth Services) Print and dissem inate SOP to the stakeholders t o the 32+1 SSPDF- (Defense 500 states Hea lth Services) Induction and training (3 days' workshop, 10pax, breakfast, SSPDF- (Defense 2,689 lunch, supplies like PPE and stationery, 3 facilitators) Hea lth Services) SSPDF- (Defense Simulation exercises for all staff (supplies for the exercises) 37,428 Hea lth Services) Select 33 foca l persons from the institutions involved at SSPDF- (Defense 0 national and sub national Hea lth Services) SSPDF- (Defense Weekly EPR meetings 0 Hea lth Services) SSPDF- (Defense Weekly IDSR bulletin 0 Hea lth Services) SSPDF- (Defense Regula r communicat ion among focal points 0 Hea lth Services) MEDICAL COUNTER MEASURES AND PERSONNEL DEPLOYMENT TARGETS National framework for transferring (sending and receiving) medical countermeasures, and public health and medical personnel from international partners during public health emergencies. NAPHS-RSS/070 South Sudan level of capabilities South Sudan does not have a national framework for the transfer of medical countermeasures, public health and medical personnel, despite a history of several PHEICs ranging from infectious disease outbreaks to armed conflict. During such emergencies, response is largely supported by relevant government agencies and international partners. This coordination gap leads to duplication of efforts sometimes, as there are no proper coordination and communication mechanisms in place. The country has yet to sign up for and explore available regional and international agreements for the sending and receiving of medical countermeasures and personnel deployment. However, the country has received and deployed personnel for various responses under the surge support plan of various partners like WHO, UNICEF and International Organization for Migration (IOM). There are limited national stockpiles of medical countermeasures, and those available are mainly for communicable diseases like measles and meningitis. The country has received large stocks of cholera vaccines periodically to help contain outbreaks. There are no agreements with international manufacturers of medical countermeasures, but an agreement with Gavi on procurement of vaccines exists. There is limited capacity for logistics management, with storage capacity being available at the national level, but state storage capacities are not known. There are no formal plans for surge staffing for public health response. Responsible Budget in Activity Authority US Dollars Objective 1. By 2020, strenatflen the system for sendln1 and recelvl111 medical countermeasures durln1 Public Health events M inistry of Recruit international con sultant for 3 months to develop the SOPs Hea lth 174, 360 Conduct data collection on assessment of storage and logistics for M inist ry of t wo days. Health 33,764 Condu ct data an alysis on the assessment of storage and logist ic M inistry of capacity Health - Draft a nationa l plan to send, receive stockpi le and deploy med ical M inist ry of cou nte rmeasu res Hea lth - Va lidation workshop (20pax, 3 days, breakfast, lunch, stationery, M inistry of transport) Health 10,590 Print and disseminate SOPs & Plan to the stakeholders for the 32+1 M inistry of states Health 2,000 Consultant to review and update legal procedures for medical countermeasures M inistry of Health - / NAPHS-RSS/071 ---~ Responsible Budget in Activity Authority US Dollars Conduct two days' workshop and testing of data col lection checklist M inistry of on legal procedures for medical counter measures. Health 7,260 Draft a national SOPs for Legal procedures for medical M inistry of countermeasures Health - M inistry of Review relevant bills for 3 days (40 pax, transport, airtimes) Health 18,930 Validation workshop to review and update legal procedures for M inistry of medical countermeasures Health 10,590 Write MoU for regional cooperation with AFENET and CDC for M inistry of importation of medical counter measures Health - Write MoU for regional cooperation with the neighboring states M inistry of and WHO regional states for deployment of medical personnel Health - during emergencies Regular review and update Profile for all staff qualifications in each M inistry of sector quarterly Health - M inistry of Identify staff for emergency roster Health - RISK COMMUNICATION TARGET South Sudan uses multilevel and multifaceted risk communication capacity. Real-time exchange of information, advice and opinions between experts and officials or people who face a threat or hazard (health or economic or social wellbeing) to their survival. This exchange allows informed decisions to mitigate the effects of the threat or hazard and to initiate protective and preventive action. This approach includes a mix of communication and engagement strategies, such as media and social media communications, mass awareness campaigns, health promo- tion, social mobilization, stakeholder engagement and community engagement. South Sudan level of capabilities The Health Education and Promotion (HE&P) department in the MoH is responsible for health promotion and community engagement. The department and a national working group implement risk communication activities during outbreaks and emergencies. Membership of the working group is limited but includes health care workers and representatives from civil society organizations, partners, the private sector, and other non-state actors. The last meeting NAPHS-RSS/072 organizations, partners, the private sector, and other non-state actors. The last meeting of the TWG was in 2016. Ad hoe TWGs for social mobilization and hygiene promotion for cholera exist and their members are mainly national NGOs. These notwithstanding, risk communication to the public is usually coordinated by the office of the President during an emergency. The capacity (human, material and funding) of the HE&P department and at the sub-national levels is very low. Risk communication is part of disease specific preparedness and response guidelines and plans for VHF, cholera, polio and meningitis. Generally, risk communication activities are ad hoe and not well coordinated at any level. There is neither a national risk communica- tion strategy nor any formal agreements between the agencies that carry out such activi- ties. It appears that there is a mechanism to coordinate communication between hospitals and the national Emergency Preparedness and Response structure at the MoH. There is also an agreement for endorsement/clearing of some risk communication materials between the MoH and some partners. No formalized systems exist for monitoring and addressing media, rumors and other misinformation. Mechanisms for surge staff for risk communication during emergencies are ad hoe. Responsible Budget in US Activity Authority Dollars Objective 1: To Improve the risk communication structure and tools Ident ify and map key mu lt i-sectora l and multi-disc iplinary Ministry of stakeholders. Li vestock & - Fish eries Merge all relevant and existi ng TWGs and formally estab lish a M in istry of unified and umbrella mu lti-sectora l/multi-disciplina ry ri sk Livestock & - communication TWG . Fish eries Establish a Secret ariat to support coordinat ion f unctions, M in istry of includ ing regu lar half-day (30 persons) monthly meet ings of the 14,400 Hea lt h unified TWG. Organ ize a one-day meeting to review the existi ng TORs fo r t he M in istry of 7,050 TWG Health Share TORs for th e risk comm un ication w orking group (Soft Copy) Ministry of - Hea lt h Conduct a two-day meeting to review existi ng draft risk M in istry of comm uni cat ion strat egy and mainst ream th e multi-hazard and Livestock & 10,380 One Health approach (40 pax, ha ll hire, refreshments, st ationery) Fisheries Meeting to Validat e and sha re th e strategy and plan wit h all th e M in istry of sta keh olders from all relevant sectors. Li vestock & 10,380 Fisheries Conduct a one-day desktop simulation t o test the plan (SO pax, M inistry of 8,342 refreshment, transport reim bursement 32+1 state pax) Health NAPHS-RSS/073 Responsible Budget in US Activity Authority Dollars Conduct a one-day desktop simulation to test the plan (SO pax, Ministry of 714 refreshment for 17 national pax) Health Endorsement of final plan by National Government Ministry of - Health Print 500 copies of the risk communication strategy (printing and Ministry of 4,000 spiral binding of strategy document) Health Conduct a dissemination and launching meeting in Juba for 50 Ministry of 800 participants (conference hall hire, refreshments) Health Develop/review/adopt mapping tools and assessment at national and sub national levels (hire an international consultant for 8 Ministry of 39,180 weeks to map, assess, analyze, write a report, and present the Health report in technical meeting, DSA, Transport, Professional fee) One Consultant Training Expert/Facilitator fo r 4 weeks Ministry of 20,340 Health 5-day workshop for 15 people for training package development Ministry of 3,800 Health Printing of training package Ministry of 1,600 Health TOT of 33 identified trainers for 32+1 states Ministry of 35,910 Health Conduct risk communication 2-days training in each of the 32+1 Ministry of states, targeting 15 participants per state. Health 144,060 Hiring a consultant for 4 weeks to develop M & E framework & Ministry of 20,340 monitoring tools Health Two days' workshop with experts from partner agencies for the Ministry of 2,880 finalization of tools (15 person) Health Hiring a consultant for 3 months to do the desk review of all Ministry of 59,370 relevant research & conduct a comprehensive KAP survey & FGDs Health Identification, recruitment & orientation of behavioral Ministry of surveillance informants and community engagement workers in 60,000 Health 10 pilot states. Identification, recruitment & orientation of behavioral Ministry of surveillance informants and community engagement workers in Health 990,000 additional 23 states Objective 2: To stre111then partners and stakeholder's coordination for risk communication Conduct a three days' workshop to develop SOPS/Guidelines for Ministry of the one health communication approach (Hote l package for 30 Livestock & 4,920 participants, transport refund for government staff, stationery) Fisheries NAPHS-RSS/074 Responsible Budget in US Activity Authority Dollars Conduct a one-day validation meeting by a w ider stakeholder Ministry of team (one day hotel package for 40 participants, transport refund 2,370 Health for government staff, stationery) Advocacy with MoH senior staff for their approval Ministry of - Health Objective 3: To strengthen publlc communication with communities durt111 Publlc Health emel"lendes Ministry of 165,000 Develop, test and print IEC materials for threat/event specific Health Develop a selection criterion for risk Communication focal Ministry of - persons Health Conduct 2 days risk communication training of t he foca l persons. Ministry of 29,412 Health Objective 4: To strengthen community e11p1ement durl111 Publlc Health emel"lencles Develop a commun ity engagement costed plan for at high risk Ministry of communities based on the VRAM findings Health Write concept note or proposal to raise f unds for risk Ministry of communication Health Hold a two days meeting at national level to develop SOPs for Ministry of effective community engagement during emergency response 1,940 Hea lth (refreshments for 15 people, transport refund, stationery) Objective 5: To enhance capacity to address rumors and misinformation before, durl111 and after Publlc Health emel"lencles, by 2019 Hold a one-day meeting to review/d evelop a tool for mapping the Ministry of 1,310 channels of rumor reporting at all levels Health Test and refine the tool (tra nsport refund, Fuel) Ministry of 7,821 Health Establish network of community-based informants for rumors & Ministry of community feedback Health 396,000 One day training of informants at State level Ministry of 43,230 Health National level orientat ion of 33 state Risk Communication focal Ministry of persons on rumor/feedback tool, data collection, analysis and Health 147,060 response. Recruit an international consultant to do evaluation rumor Ministry of 20,440 management post public health events Health Intensification of Risk Communication activities within first 72 Ministry of hours of an outbreak/event. Hea lth 825,000 NAPHS-RSS/075

0TH — ER I HR-RELATED HAZARDS AND POi NTS OF ENTRY

0TH ER I HR-RELATED HAZARDS AND POi NTS OF ENTRY POi NTS OF ENTRY TARGET States Parties designate and maintain core capacities at international airports and ports (and where justified for public health reasons, a State Party may designate ground cross- ings) that implement specific public health measures required to manage a variety of public health risks. South Sudan level of capabilities The control and containment of diseases and other potential public health risks remains a fundamental element for the implementation of the IHR at designated PoEs. Routine capacities must be in place at designated PoEs including for the assessment and care of ill travelers, trained personnel for the inspection of conveyances, as well as facilities for the holding and transfer of ill travelers. A competent authority must be responsible for the supervision and provision of healthcare at the PoEs. So far in South Sudan there is no port health unit which would oversee health centers and vaccination centers for international travelers in the country. There are four main points of entry in South Sudan earmarked as designated PoEs in the coming two years, they include: Juba International Airport (JIA), Nimule ground crossing with Uganda, Jada ground crossing with Sudan, and Renk river crossing with Sudan. During the JEE assessment, the team visited JIA and Nimule ground crossing, to assess their capacity. The assessment showed that only JIA has three port health personnel, and none of them conduct routine screening for travelers. On the other hand, Nimule has no health personnel at the border crossing. Immigration officers in Nimule sometime asks travelers to show proof of vaccination and they advise them to get vaccinated in Juba for those who do not have it. Currently, the health personnel working in JIA have no designated area for the provision of health services such as vaccinations. JIA is therefore still unable to correctly apply the IHR procedures. Once the new terminal is completed, there will be dedicated space for port health services, already earmarked by the authorities. On the other hand, in Nimule, space for health personnel may be obtained after negotiation between the heads of immigration and health departments. Responsible Budget in US Activity Authority Dollars Objective 1:To sustain 24 houn routine port health services In six(&) PoEs

6 — PoEs for assessment, 7 staffs per each Team, days for

6 PoEs for assessment, 7 staffs per each Team, days for Ministry of assessment(7 Renk, 4 Nadapal, 3 Nimule, 1 Juba, 3 Nabiapai and Transport - (Civil

3 — Kaya). Air transport to Renk, Nada pal, Wau, Nabiapai, Kaya, 449,400

3 Kaya). Air transport to Renk, Nada pal, Wau, Nabiapai, Kaya, 449,400 Aviation) Nimule and ground facilitation in 6 PoEs. PoE checklist. NAPHS-RSS/076 Responsible Budget in US Activity Authority Dollars Ministry of 5day for TWG to develop NPHCP (Juba) Transport - (Civil 97,935 Aviation) Procure 6 ambulance for 6 PoEs. Medical supplies and Ministry of equipment for the 6 PoEs ho lding areas, provide renumeration Finance 360,000 for 50 staff Recruit staffs to run the 6 POE in the identified locations Ministry of Health 750,000 Ministry of Equipment and food Transport - (Civil 4,000 Aviation) Conduct 5 days training in Juba for 36 PoEs staffs ( 2 back to back three days trainings): (5 Renk,5 Nadapal, 7 Nimule, 4 Ministry of Health 132,405 Nabiapai,7 Kaya & 8 Juba.) Objective 2. To develop, Implement and test Emergency Communication Plan (ECP) at 4 PoEs Conduct a one day meeting to develop a position paper on port Ministry of Hea lth health services for MOH to be presented to the cabinet. 660 Conduct a half day meeting to develop a position paper on port M inistry of health inspection for ministry of agriculture and animal Agriculture 660 husbandry to be presented to the cabinet. Ministry of Conduct high level stakeholder's engagement meeting Interior 83,070 M inistry of Conduct 3 days' workshop for 30 staff to develop the Health/ M inistry communication plan in Juba 11,970 of Agricult ure conduct 3 days' workshop for 30 staff to develop IEC Materia ls in Ministry of Health Juba 11,970 1 day conduct a field test of the IEC material in 7 selected PO Es Ministry of Hea lth 6,786 M inistry of Conduct quarterly monitoring and supportive supervision visits Transport - (Civil at PoEs (3 staffs). 46,150 Aviation) Train 50 staff for 3 days on mobility monitoring at 7 POE sites. M inistry of Procure and train 50 staff on using mobility monitoring Transport - (Civil 231,130 equipment. Aviation) Conduct 2 days national functional simulation exercise (FX) for Ministry of Health 50 staff 208,230 To establish a dedicated port health services department in MOH Ministry of Health 120,000 NAPHS-RSS/on Responsible Budget in US Activity Authority Dollars Procure thermal scanners for JIA and Nimule PoE and designate Ministry of PoE Port Health Authorities for implementation of routine and Transport - (Civil 30,000 emergency IH R activities Aviation) CHEMICAL EVENTS TARGET States Parties with surveillance and response capacity for chemical risks or events. This area requires effective communication and collaboration among the sectors responsible for chemical safety, industries, transportation and safe disposal. South Sudan level of capabilities The country has limited overall capacity in this area but has a National Environment Policy (2015-2026). The policy mandates the Ministry of Environment to effectively protect and sustainably manage the environment and natural resources to ensure a quality environment adequate for human health and wellbeing of all those who reside in South Sudan. Additionally, an environmental bill is in draft form and currently under review. The Petroleum Act is in place and contains provisions for "health, safety and protection of environment". The country has oil drilling sites in Upper Nile and Unity states. In April 2016, a multisectoral investigation was commissioned by government to investi- gate a chemical event in Paloich oil fields in Melut county. A cluster of 90 individuals assessed reported non-specific symptoms including fevers, general weakness, paresthe- sia, abdominal pains, and erectile dysfunction. Toxicological investigations revealed exposure to heavy metals - Mercury, manganese, and selenium. Responsible Budget in US Activity Authority Dollars Objective 1: To develop, lepl Instruments for effective Implementation and enforcement of chemical events to support lntearated national environment and health surveillance systems Conduct 5 days' workshop for policy and SOPs drafting and Ministry of 22,505 on e day for validation (40 staffs). Environment Ministry of One day val idation meeting for policy and SOPs (40 staffs). 9,525 Environment Hire an international consultant for 6 months (co nsultant ToR Ministry of 51,000 lr to be confirmed) Environment / -----~ NAPHS-RSS/078 Responsible Budget in US Activity Authority Dollars Laboratory functiona l; purchase equipment and consumables, Ministry of 150,000 requirements determined during needs assessment Environment Objective 2: To establish a national chemical surveillance and response system In real time report1111 at 50% Ministry of Three days' workshop for 30 staffs in Juba 8,995 Environment Recru it an international consultant to develop the al l ha zard Ministry of 20,440 and preparedness plan 1 month Environment One day meeting to establ ish and inaugurate the TWG (10 Ministry of 780 staffs) Environment Ministry of Quarterly meetings of the TWG (10 pax) 14,040 Environment Recru it an international consultant to develop SOPs and Ministry of 20,440 guidelines Petroleum Five days' workshop for development of the plan for 30 staffs Ministry of 20,255 + additiona l One day Validation meeting Petroleum One day Validation meeting for emergency response to Ministry of 8,995 chemica l events plan Environment Five days' workshop to develop t he guideline (30 staffs)+ Ministry of 20,255 addit iona l One day for Validation Petroleum One day Validation of Nationa l guidelines and manuals for Ministry of 8,995 surveillance, assessment and management of chemical events Environment Recru it an international consultant to develop the reporting Ministry of 20,440 tools Environment Conduct two days sta keholder meeting for 20 pax to estab lish Ministry of 2,420 and agree on the reporting channels Environment RADIATION EMERGENCIES TARGET States Parties with surveillance and response capacity for radiological and nuclear hazards/events/ emergencies. This area requires effective communication and collaboration among the sectors responsible for radiological and nuclear emergency management. South Sudan level of capabilities South Sudan has limited to no capacity in the area of radiation emergencies, as they are not a priority at the national level in any surveillance, detection or response planning. NAPHS-RSS/079 Capacity and expertise in this area is lacking in South Sudan and the country needs technical and financial support to build up its resilience at the National and sub-national levels. Responsible Budget in US Actions Authority Dollars Objective 1: To strenphen surveillance and response to nuclear and radlolOBlcal hazards with S. routine reporting from Identified nudear and radloloilcal hazard sites conduct two days stakeholders meeting to form the board Ministry of 1,940 (15 staff) Environment conduct a 1 days meeting with WHO Country office for Ministry of 780 signing the MOUs (10 Staffs) Environment Hiring a consultant for 1 month to support the development Ministry of of Radiation emergencies SOPs and guidelines and MOUs, Environment 20,440 including assessment of centers for testing radiological substances Conduct a 2 days' workshop to incorporate the radiological Ministry of and nuclear response plan into public health incident and Environment 3,380 emergency response plan (30 staffs) Objective 2: To develop, Implement and test a national radiation emerpncy response plan Conduct 3 days' workshop for developing the response plan Ministry of 4,920 (30 staffs). Environment Conduct 5 days training to relevant staffs on Response to Ministry of 8,000 radiation emergencies (30 staffs) Environment Ministry of Conduct 2 days functional simulation exercise for 30 staffs. Environment 10,140 Conduct 3 days' workshop for developing the radiati on Ministry of 4,9 20 emergencies action plan (30 staffs). Environment NAPHS-RSS/080 ANNEXES ACRONYMS/ABBREVIATIONS AAR: After Action Review SSO: State Surveillance Officer IDSR: Integrated Disease Surveillance and Response IHR: International Health Regulations IHRMEF: International Health Regulations Monitoring & Evaluation Framework JEE: Joint External Evaluation MDAs: Government Ministries, Departments and Agencies M&E: Monitoring and Evaluation NAPHS: National Action Plan for Health Security NSC: National Steering Committee SWOT: Strengths Weaknesses Opportunities Threats ICT: Information Communication Technology TC: Technical Committee TTX: Tabletop Exercise EPR: Emergency Preparedness and Response EWARS: Early Warning Alert & Response System EWARN: Early Warning Alert & Response Network EBS: Event Based Surveillance BHI: Barna Health Initiative MoH: Ministry of Health MoJ: Ministry of Justice MHADM: Ministry of Humanitarian Affairs and Disaster Management PHEIC: Public Health Events of International Concern WHO: World Health Organization FAO: Food Agriculture Organization OIE: World Organization for Animal Health NPHEPR: National Public Health Emergency Preparedness & Response EOC: Emergency Operations Center IMS: Incident Management System USO: United States of American Dollar PHEOC: Public Health Emergency Operations Center NAPHS-RSS/081 AGENDA FOR THE VALIDATION AND COSTING WORKSHOP AGENDA Workshop to Validate and Cost National Action Plan for Health Security, From 16th -20th September 2019 Juba Landmark Hotel Time Activity Moderator Day 1 08.30- Registration 09.00 09.00- Introduction, Opening remarks, Objectives, expected Outcomes 10:00 Official Opening: • Remarks by WHO Representative Dr. Loi • Remarks by Ministry of Cabinet Affairs • Opening remarks by Hon. Minister of Health • Objectives and expected outcomes of the workshop: Presenter Dr. Loi • From JEEs to National Action Planning, Regional Experience; Presenter: WHO AFRO 10.00- Administration announcements, Group Photograph and Coffee Break 10.30 30 min Governance st ructure of NAPHS monitoring and implementation Present er: NFP Sout h Suda n/ Dr. ltin 30min Introduction of the benchmarks document Present er: W HO (GVA or AFRO} 1 hour NAPHS validation and costing process Presenter: Costing expe rt s WHO The technical area Once a technical Once the activities are Technical leads will present the area is reviewed, the finalized, the technical focal Area activities for their technical focal points points will meet with experts Leads technical area in will meet the costing NAPHS-RSS/082 nme Activity Moderator plenary (15 mins). The in a separate room to finalize experts in a separate presentation will be the detailed activities room to finalize followed by a guided costing of the discussion {30 mins). activities. Technical area 1: National legislation, Policy and Financing; Dr. Loi/ Dr. ltin • Presentation No meetings No meetings (15 mins) • Discussion (30 mins) Technical area 2: IHR Coordination, Technical area 1: National Communication and legislation, Policy and Advocacy; Dr. Loi/Dr. No Meetings Financing ltin Detailing activities Presentation {15 mins) Discussion (30 mins) Technical area 3: Technical Antimicrobial Technical area 2: IHR Technical area 1: Area Resistance; Mr. Abe Coordination, Communication National legislation, Leads Gordon and Advocacy Policy and Financing Presentation (15 mins) Detailing activities Costing Discussion (30 mins) Technical area 4: Technical area 2: IHR Technical Zoonotic Disease; Min Technical area 3: Coordination, Area of Livestock& Fisheries Antimicrobial Resistance Communication and Leads Presentation {15 mins) Detailing activities Advocacy Discussion (30 mins) Costing Technical area 5: Food safety; Technical area 3: Technical area 4: Zoonotic Min of Livestock& Anti microbia I Diseases Fisheries (CODEX FP) Resistance Detailing activities Presentation {15 mins) Costing Discussion (30 mins) Technical area 6: Biosafety Biosecurity; Technical area 4: Technical area 5: Food safety Mr. Abe Gordon Zoonotic Diseases Detailing activities Presentation {15 mins) Costing Discussion (30 mins) / Technical area 7: Immunization ; Dr. Technical area 6: Biosafety Technical area 5: Antony Lako Biosecurity Food safety Presentation {15 mins) Discussion (30 mins) Detailing activities Costing / NAPHS-RSS/083 nme Activity Moderator Technical area 8: National Laboratory Technical area 7: Technical area 6: System; Mr. Michael Immunization Biosafety Biosecurity Lasuba Detailing activities Costing Presentation {15 mins) Discussion (30 mins) Technical area 9: Real Time Surveillance; Mr. Technical area 8: National Technical area 7: Mathew Tut Laboratory System Immunization Presentation {15 mins) Detailing activities Costing Discussion (30 mins) Technical area 10: Technical area 8: Reporting; Mr. Technical area 9: Real Time National Laboratory Mathew Tut Surveillance System Presentation (15 mins) Detailing activities Costing Discussion (30 mins) Technical area 11: Workforce Technical area 9: Development; MoH/ Technical area 10: Reporting Real Time HR Detailing activities Surveillance Presentation {15 mins) Costing Discussion (30 mins) Technical area 12: Preparedness; Mr. Technical area 11: Workforce Technical area 10: Mathew Tut Development Reporting Presentation (15 mins) Detailing activities Costing Discussion {30 mins) Technical area 13: Emergency Response Technical area 11: Technical area 12: Operations; Mr. Workforce Preparedness Mathew Tut Development Detailing activities Presentation (15 mins) Costing Discussion (30 mins) Technical area 14: Linking Public Health and Security Technical area 13: Emergency Technical area 12: Authorities ; SSD Response Operations Preparedness Military Corps Detailing activities Costing Presentation {15 mins) Discussion (30 mins) Technical area 15: I/ Medical Technical area 14: Linking Technical area 13: Countermeasures and Public Health and Security Emergency Response Personnel Authorities Operations Deployment; Mr. Mathew Tut Detailing activities Costing / NAPHS..RSS/084 nme Adlvtty Moderator Presentation (15 mins) Discussion (30 mins) Technical area 16: Risk Technical area 14: Technical area 15: Medical Communication ; Ms Linking Public Health Countermeasures and Mary Obat and Security Personnel Deployment Presentation (15 mins) Authorities Detailing activities Discussion (30 mins) Costing Technical area 15: Technical area 17: Medical Points of Entry ; Technical area 16: Risk Countermeasures Zacharia Modi Communication and Personnel Presentation (15 mins) Detailing activities Deployment Discussion (30 mins) Costing Technical area 18: Chemical Events; Technical area 17: Points of Technical area 16: Ministry of Petroleum Entry Risk Communication Presentation (15 mins) Detailing activities Costing Discussion (30 mins) Technical area 19: Radiation Technical area 18: Chemical Technical area 17: Emergencies; Ministry Events Points of Entry of Environment Detailing activities Costing Presentation (15 mins) Discussion (30 mins) Technical area 19: Radiation Technical area 18: Emergencies Chemical Events Detailing activities Costing Technical area 19: Radiation Emergencies Costing Review of pending issues NAPHS Coordination: Representation of key programs/agencies on NFP • Presentation of activities (15 mins) • Discussion (75 mins) Presentation of the National Action Plan for Heath Security (Vision, Mission, Core values, Objectives, strategic actions) The cost implication of the National Action Plan for Heath Security Way forward (Post NAPHS) • Presentation of activities (15 mins) • Discussion (45 mins) Presenter: MoH/WHO AFRO Closing ceremony NAPHS..RSS/085

South Sudan National Action Plan for Health Security (NAPHS) 2020-2024

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