Using LQAS to monitor performance of health services in refugee camps‚ Yida‚ Unity State‚ South Sudan

In refugee camps, agencies monitor performance of health services and impact of health interventions by reports of service provision, cases of illness (morbidity rates) and deaths (mortality rates) across the camp. Differences in access, use of services, and health status among refugees are not routinely measured. It is complex and expensive. Our project will provide this information using a different type of survey called Lot Quality Assurance Sampling (LQAS) which uses small samples to measure if coverage of health services reaches pre-determined targets or not. We proposed to complete the survey in Yida, a well-established camp located in Pariang County which hosts refugees from Sudan with different cultural contexts, health needs, and health behaviour. We want to know how we are doing (are we providing enough water, food, shelter, health?) and how can we do better. The survey in Yida was scheduled at the same time as the 2014 LQAS survey in all 79 counties. This way, we can also compare camp and host community services' effectiveness and provide data for planning to camp agencies, Pariang County and Unity State Ministry of Health (MOH).

Prior to this the Liverpool School of Tropical Medicine (LSTM) which works in South Sudan since 2009 had supported proof-of- concept LQAS surveys in Yida and Maban camps. Both showed unexpected differences in access to basic services in camp sections, which were promptly corrected by camp managers and agencies. We had already observed surprising differences in health services' performance of counties during the 2011 national LQAS survey: some unsupported counties were doing better than others with more support, which were struggling to reach standards.

Our work in South Sudan included support to the health management information system, which was made possible by the extraordinary team work of MOH health officers and partners. We were privileged to be part of this team. In 2010 we were training State M&;E officers who had never managed databases; in 2013 they were managing it and training counties and NGOs. Incorporating refugees’ services to the system was next. We developed Yida proposal with our colleagues from Juba and Bentiu and once approved we were on our way to Bentiu and Yida to continue planning. We received very positive feedback and support: Unity SMOH designated our counterpart and UNHCR facilitated our visit to Yida on 5^th December to present the methodology, discuss sampling procedures, population figures, indicators, community engagement, training and timing for data collection and analysis.

We worked on the questionnaire and indicators and booked a second flight to Bentiu on 15 December. Our team never boarded that plane. Sudden violence spread across the country… At least one of our South Sudanese colleagues is dead; others are missing or non-contactable, UNHCR and agencies are desperately trying to meet the needs of half a million displaced persons… people's, homes and businesses have been devastated…

We have just returned to Juba. The ceasefire offers hope but it seems a century has passed since we shared the dream of a new country with capable, enthusiastic, and talented South Sudanese, building a future after years of struggle. Now the dream is shattered by news of death and displacement. We join forces to continue. This is our way to pay tribute to our colleagues who will not be there with us.