NAME OF VISIT

RI SUPERVISORY TRIP REPORT

Name of supervisor: James Tong, County: Rubkona,Date of Report: 30th April 2024

1. INTRODUCTION:
Rubkona County is one of the nine counties in Unity State with ten payams including Bentiu town and Bentiu
IDPs. Due to unresolved issues of last month especially stock out of antigens and Child Health cards with total
performances of 81% last month visits to 75% performances in this current visit. Rubkona County has received 9
solar fridges in March 2024 with only Reang PHCU and Sector 1 PHCC received new fridges while 7 of them are
being stationed at the CHD office as CHD cold chain for easy vaccines supplies according to CHD.

another gap in Bentiu IDPs, Sector 4 PHCC and sector 2 PHCC doesn’t have functional fridges they are getting
their vaccines supplies from the Humanitarian logistical base, Nhialdiw PHCC and Koythey PHCU get their
vaccines from SMOH cold room.

Rubkona County has 16 RI-providing HFs of which seven of the RI-providing HFs have active cold chains.

But all the nine solar fridges installed in Rubkona are not functioning well 80% of the new installed fridges
temperature records is between +9 and above, so this required technician checkup.

The purpose of his supervisory visit

 To assess the EPI activities in the HFs as well as in the CHD and provide on-the -Job training
based on the identified gaps
 Capacity building on RI activities for vaccinators and CHD staff
 To make sure that all the RI monthly reports are entered into the DHIS2 platform on a
monthly basis.
1. Key issues identified in the last visit:
 Stock out of the two antigens, BCG and OPV
 Child Health Cards and tally sheets stock out of the county.
2. Formation of the supervisory team:
 John Bighar Machar acting EPI officer
 Bentiu Gatnin Reang –CHD M&E officer
 James Tong Dak- Cluster officer – AFH –Bentiu
 Claire Nakadimo – EPI Focal person –CORAID Reproductive Health Specialist

20200217
 3. Places visited and persons met during supervision:

Name of the visited Payam Name of the visited Health facility Contacted person in the sites
Bentiu town Bentiu state Hospital Puol Ruei & Michael chieng
Koythey PHCU Kuol Yoal Badeng
Rubkona Yoanyang PHCU Angeline Nyanthiaw
Rubkona PHCC Yang Baret Gai
DingDing PHCU Simon Gattour
Kaljak Kaljak PHCC Bentiu Jal
Bentiu IDPs (POCs) IOM sector 1 clinic Gabriel Kim
World relief sector 2 clinic Jimmy Kuiy
IRC sector 4 clinic David Diew
IOM sector 3 clinic Chidong Both
Budang Budang PHCU Giel Ruazel,
Reang PHCU Wewu Ruazel

2. EXECUTIVE SUMMARY:
The CHD in collaboration with different partners like CORDAID, IRC, IOM, and world relief are doing their
best to improve the RI performance of the county and provide better quality of service for the
community.
Poor data quality and low defaulter tracing mechanism in most of visited HFs. The team observed that
most of the vaccinators had good knowledge and skill in providing Immunization. We observed sufficient
RI data tools, AD and mixing syringes in most of the HFs and good waste disposal systems in most of the
visited health facilities.
During this visit, the major gaps that were identified by the supervisory team were, Data discrepancy,
incorrect filling of EPI monitoring charts, and a poor defaulter tracing system and inappropriate waste
disposal mechanism especially in Budang, Reang and Dingding PHCCs where there is no incinerators.

3. FINDINGS/KEY ACTIVITIES ACCOMPLISHED

3. A Successes/Strengths:

 All visited HFs had a list of Boma/ village with the updated target population, <1yr children, PW,
NPW, and Immunization session plan and carried out as scheduled.
 86% of the visited HFs has up-to date’s catchments area maps with features and strategies.
 The 7 HFs that has functional cold chain has a filled temperature twice a day.
 All vaccines were in stock with usable, and were arranged in the refrigerator properly.
 70% of the visited HFs the team attended EPI sessions,
o The vaccines and diluents were in plastic bags and 4 conditioned Icepacks with foam pads.
o Had sufficient syringes in al visiting health facilities

20200217
 o The HWs were performing injections in the correct site, dose, and route of administration.
o The vaccinators were verifying the age of the infant and reviewed records.
o All the used syringes with needles were disposed of in a safety box
 The CHD developed the PA by PA situational analysis so that the target population has known.
 The CHD developed the Quarter work plan for the last quarter
 The CHD had conducted regular supportive supervision using a checklist last quarter and monitor
the performance of the health facilities using the performance ranking tool .
3. B Gaps/obstacles:

 Inappropriate waste disposal especially in Budang, Reang, and Dingding PHCU

 Almost all the visiting Health facility doesn’t have vaccines and injection Material control books.
 Data discrepancies still a challenges though it’s improving from some health facilities.
 Some of the RI monitoring charts were not updated and plotted last month.
 Lack of proper defaulter tracing mechanism in most of the visited health facilities in Rubkona
County.
 All the visited health facilities with new fridges doesn’t have temperature charts for daily records
 There is no temperature charts and vaccines control books for CHD office
 OPV and BCG vaccines stock out.
 Some of the health facilities didn’t managed to their EPI monitoring charts.
4. c. Action taken:
During the visit I and the team coached the vaccinators on the following :

 We developed some of the defaulters list together with vaccinators and advices to
developed on monthly basis.
 Together with vaccinators all the monitoring charts were filled and plotted including the
CHD office EPI monitoring charts.
 CHD and IP agreed advised to construct the incinerators for Reang, Budang health facilities.
 Vaccines requisition being submitted to SMOH for vaccines and accessories supplies.
5. Old and New Critical issues and problems remaining to be resolved:
 Poor defaulter tracing mechanism
 Inappropriate waste disposal site
 Lack of vaccines control books especially in health facilities with new fridges.
 Lack of temperature charts
6. RECOMMENDATIONS:
1. Strengthening of social mobilization in Rubkona County especially by social mobilization team
and CHD.
20200217
 2. Continuous supportive supervision on monthly basis to for quality data submission
3. CHD EPI office and M&E should always make sure all the monthly RI reports are submitted to
their office and enter into DHIS2 by the end of each month
7. CONCLUSION:
To strengthen RI activities in the County all health supporting partners should always collaborate with
CHD by doing regular and joins Supportive supervision and monitoring the RI performance of each
health facility, the CHD is trying its own best to provide a better quality of RI service for the community.
Comparing the overall average supportive supervision score of the previous visit which was 88% and this
visit's average score shows 88% hence, this shows the RI service in Rubkona County is improving at the
health facilities levels.
8. Annexes:

20200217
 Data falsification/verification

Name of Health Bentiu State

Facility Hospital Koythey PHCU Reang PHCU Budang PHCC Yoanyang PHCU Rubkona PHCC
Registe Repor Repor Registe Registe
Antigen r Reports Register t Register t Register Report r Report r Report
BCG 113 134 54 54 10 10 41 41 10 19 88 97
Penta1 154 111 72 72 40 40 30 30 22 31 100 188
Td 87 98 67 67 77 77 42 42 21 29 100 100

Name of Health
Facility Sector 1 PHCC Sector 2 PHCC Nhialdiw PHCC Kaljak PHCC Dingding PHCU
Repor
Antigen Register Reports Register t Register Report Register Report Register Report
BCG 58 58 107 107 84 98 114 124 65 38
Penta1 78 86 75 75 70 123 111 118 32 50
Td 23 29 29 29 20 47 99 88 15 10

20200217
 Rubkona County Health Facilities Performance
April 2024
100%
88% 88% 86%
90% 80% 80% 80% 80%
80% 77% 76% 76% 75%
72% 71%
70%
60%
50%
40%
30%
20%
10%
0%
ta
l U U CC CC CC CC na U CC U or
e
or
e
pi PHC HC PH PH PH PH bko HC PH PHC Sc Sc
s P P k
Ho he
y g ng r1 r2 di
w Ru g ja ng ag
e D
te yt e an uda cto cto i al yan Kal g di er CH
a o R e e n n Av
St K B S S Nh Yo
a Di
ti u HF
B en

Health Facilities

20200217
 NNEX 1

Bentiu State Koythey PHCU Reang PHCU Budang PHCU Sector 1 Sector 2
Health Facility Name
Hospital PHCC PHCC
Name of the supervisor James Tong James Tong James Tong James Tong James Tong James Total
Date of Visit 22/04/2024 22/04/2024 23/04/2024 23/04/2024 24/04/2024 24/04/2024 ( County)
S.N Activities Yes/No/NA Yes/No/NA Yes/No/NA Yes/No/NA Yes/No/NA Yes/No/NA # yes % Yes
1 Up to date estimate of target groups Yes Yes Yes Yes Yes Yes 11 100%
2 Catchment area map with basic features displayed Yes No Yes Yes Yes Yes 9 82%
3 RI session plan displayed Yes No Yes Yes Yes Yes 10 91%
4 All planned sessions carried out last month Yes Yes Yes Yes Yes Yes 8 72%
5 Complete/correct temperature monitoring chart Yes Yes No Yes No No 6 60%
6 Current temperature between +2°C to +8°C Yes Yes No Yes No No 7 70%
7 All vaccines and diluents in stock Yes Yes No No Yes Yes 7 64%
8 All vaccines in stock usable No Yes Yes Yes Yes Yes 8 73%
9 Vaccines arranged correctly Yes Yes NA Yes Yes Yes 10 90%
10 Date of opening written & no reconstituted vials Yes Yes Yes Yes Yes Yes 11 100%
11 Up-to-date/correct stock control book No No No No No No 2 20%
12 Vaccine/diluents brought to session correctly Yes Yes Yes No Yes Yes 8 72%
13 All vaccines/ diluents available during the session Yes Yes Yes Yes Yes Yes 9 82%
14 Diluents for BCG and Measles are correct Yes Yes Yes Yes Yes Yes 11 100%
15 Sufficient syringes /needles Yes Yes Yes Yes Yes Yes 11 100%
16 Vaccinator verifies infants’ age and records Yes Yes NA NA Yes Yes 7 100%
17 Vaccines administered correctly Yes Yes NA NA Yes Yes 7 100%
18 Used needles/syringes placed in a safety box Yes Yes NA NA Yes Yes 7 100%
19 Key messages provided to parents/caregivers Yes Yes NA NA Yes Yes 6 100%
20 Five RI management data tools available and used Yes Yes Yes Yes Yes Yes 9 82%
21 RI registers (child and Td) filled correctly Yes Yes Yes Yes Yes Yes 11 100%
22 Data the same in the Registers and Monthly Report for BCG, No Yes Yes Yes No Yes 6 55%
Penta1 and Td1.
23 RI monitoring chart displayed, correct, up-to-date Yes No No Yes Yes No 7 64%
24 Drop out tracing mechanism in place Yes Yes Yes No Yes Yes 7 64%
25 Appropriate waste disposal site Yes No Yes No Yes Yes 7 64%
Total YES 22 20 13 20 21 20 196
Number of Applicable Questions 25 25 18 25 25 25 257
%YES 88% 80% 72% 80% 88% 80% 76%
County RI Supervision Summary (Facility-by-Facility)

20200217
 Nhialdiw PHCC Rubkona PHCC Yoanyang Kaljak PHCC Dingding PHCU
Health Facility Name
PHCU
Name of the supervisor James Tong James Tong James Tong James Tong James Tong Total
Date of Visit 25/04/2024 26/04/2024 26/04/2024 27/04/2024 29/04/2024 ( County)
S.N Activities Yes/No/NA Yes/No/NA Yes/No/NA Yes/No/NA Yes/No/NA # yes % Yes
1 Up to date estimate of target groups Yes Yes Yes Yes Yes 11 100%
2 Catchment area map with basic features displayed Yes Yes Yes Yes No 9 82%
3 RI session plan displayed No Yes Yes Yes Yes 10 91%
4 All planned sessions carried out last month Yes Yes Yes Yes Yes 8 72%
5 Complete/correct temperature monitoring chart NA No Yes Yes Yes 6 60%
6 Current temperature between +2°C to +8°C NA Yes Yes Yes Yes 7 70%
7 All vaccines and diluents in stock Yes Yes No Yes No 7 64%
8 All vaccines in stock usable Yes Yes Yes Yes Yes 8 73%
9 Vaccines arranged correctly Yes Yes Yes Yes Yes 10 90%
10 Date of opening written & no reconstituted vials Yes Yes Yes Yes Yes 11 100%
11 Up-to-date/correct stock control book NA No Yes Yes No 2 20%
12 Vaccine/diluents brought to session correctly Yes No Yes No Yes 8 72%
13 All vaccines/ diluents available during the session Yes Yes No Yes No 9 82%
14 Diluents for BCG and Measles are correct Yes Yes Yes Yes Yes 11 100%
15 Sufficient syringes /needles Yes Yes Yes Yes Yes 11 100%
16 Vaccinator verifies infants’ age and records Yes Yes Yes NA NA 7 100%
17 Vaccines administered correctly Yes Yes Yes NA NA 7 100%
18 Used needles/syringes placed in a safety box Yes Yes Yes NA NA 7 100%
19 Key messages provided to parents/caregivers Yes Yes No NA NA 6 100%
20 Five RI management data tools available and used Yes No No Yes Yes 9 82%
21 RI registers (child and Td) filled correctly Yes Yes Yes Yes Yes 11 100%
22 Data the same in the Registers and Monthly Report for BCG, Penta1 and No No Yes Yes No 6 55%
Td1.
23 RI monitoring chart displayed, correct, up-to-date No Yes Yes Yes Yes 7 64%
24 Drop out tracing mechanism in place No Yes No Yes No 7 64%
25 Appropriate waste disposal site No Yes Yes No Yes 7 64%
Total YES 17 20 19 18 15 196
Number of Applicable Questions 22 25 25 21 21 257
%YES 77% 80% 76% 86% 71% 76%

20200217
 ANNEX 2

CHD Level Routine Immunization Supportive Supervision Summary (CHD summary)

County Name Rubkona
Visitor’s Name(s) James Tong
Number of Payams 10
Number of Health Facilities Providing RI Services 16
Date of Visit 30 April 2024
S.N Activities Yes/No/NA
1 Payam-by-Payam situation analysis (P1) Yes
2 Up to date estimate of target groups Yes
3 Consolidated Health Facility and CHD session plan by strategy Yes
4 Quarterly Work plan Yes
5 Inventory of Cold chain equipment Yes
6 Complete/correct temperature monitoring chart No
7 Have Fridge Tag2 and corresponding figure of Temperature monitoring No
8 Up-to-date/correct stock control book No
9 Estimate of the vaccine and immunization supplies Yes
10 All vaccines in stock usable Yes
11 Vaccines arranged correctly Yes
12 Up-to-date data base (P3) training status of vaccinator Yes
13 Up-to-date RI report receipt monitoring chart Yes
14 Monthly RI report submission Yes
15 Five RI management data tools available Yes
16 County use DHIS2 for RI reporting Yes
17 Quarterly RI performance data and supervision summary Yes
18 RI monitoring chart displayed, correct, up-to-date No
19 Supportive supervision conducted by County EPI team Yes
20 Health facility RI Supervisory checklist, filled out Yes
Total YES 15
Number of Applicable Questions 20
%YES 75%

20200217