Scaling-up access to skilled birth attendance in the newest country of the world: The wau county (South Sudan) experience

Background: South Sudan has one the highest maternal mortality ratio in the world with 2,054 deaths per 100,000 live births. More than 80% of women still deliver at home with only 10-15% of births attended by skilled attendants, and there is little access to emergency obstetric care. Intervention and Results: The JSI Wau Family Health Project initiated a comprehensive skilled delivery promotion approach in Lokoloko Primary Health Care Center (PHCC) in March 2012. The intervention included: 24/7 Clinic access, staff trained on BEmONC, improved client-friendly approach, essential medical equipment, drugs and contraceptives. Community Village Health Committees promoted clinic antenatal visits, delivery and postpartum care. Traditional Birth Attendants bring women to deliver at the clinic and accompanied them during delivery. New mothers and babies stay for 24 hours after delivery to learn about breastfeeding, newborn care, and healthy birth spacing. The new service was so well accepted that the number of monthly skilled deliveries has risen from 0 (pre-intervention) to 50 (post-intervention) in 6 months. Antenatal visits also increased. Intervention scale up in the County is ongoing, showing similar encouraging results. The leadership of the County Health Department and State Ministry of Health on project implementation and scale up guarantees its sustainability. Conclusion: The involvement of local leadership in each step of the implementation and sequentially applying ‘upstream' and ‘downstream' interventions as well as a number of innovative approaches were essential for the success of the intervention. The county scale up also is resulting in important lessons learned.