Envisioning a South Sudan where everyone lives a healthy life
The conflict that has been ongoing in South Sudan since 2013 was still an active threat for most of 2018, affecting the delivery of preventive and curative health services to the population. The health system had been weakened with a breakdown in supply chains, high turn-over and inadequate capacity of the health workforce, threats to the safety of health service providers, and funding gaps. There was continuous population movement either due to forced displacement or in search of safer living conditions within or outside the country. All the while, WHO continued to work alongside the Ministry of Health to ensure access to quality, timely and affordable health care for the people. At the close of the year 2018, relative peace returned, creating an enabling environment for WHO and partners to maximize their support to the Ministry of Health.
Following South Sudan’s adoption of WHO’s “Treat All” strategy for HIV in 2017, the promise of treatment upon diagnosis encouraged more people to want to know their status, resulting in a 20% increase in 2018 in the number of people diagnosed as having HIV in their blood. WHO continues to work to further increase the number of people testing for HIV. The country’s national HIV treatment guideline has been updated in alignment with WHO’s global guideline, “Update on Antiretroviral regimens for treating and preventing HIV infection and update on Early Infant Diagnosis of HIV” for implementation in 2019.
South Sudan has continued to detect, notify and treat new and relapsed tuberculosis (TB) cases, identifying more than 10 000 cases, 76% of whom were pulmonary and 12% had TB/HIV co-infection. A 56% coverage of TB treatment was achieved.
WHO supported the country to scale up detection and management of multidrug resistant TB (MDR TB), and the country notified 23 multi-drug resistant and rifampicin-resistant TB (MDR/RR TB) cases, 18 of whom were placed on treatment.
WHO supported the implementation of Periodic Intensification of Immunization (PIRI) in seven states, immunizing 42 709 children with Penta 3 and 52 371 with Measles vaccines. An integrated immunization campaign against meningitis, measles, polio and tetanus toxoid was conducted in four counties of Greater Upper Nile that had not received immunization services for the past two years. The costed National Immunization Multi-Year Plan for the period 2018–2022 has been developed. WHO will support the country to mobilize resources for immunization using the plan.
The country continues to be polio free with the last case of wild polio virus reported in 2009. In 2018, a total of 448 acute flaccid paralysis (AFP) cases were reported, with a non-polio AFP rate of 5.5/100 000 under 15-year children and stool adequacy rate of 85%. The non-polio AFP rate is above global targets.
Three rounds of polio vaccination campaigns were held in March, April and November of 2018, reaching 77%, 92% and 93% of the targeted under-five children, respectively, with two drops of bivalent oral polio vaccine (bOPV). In anticipation of the Global Polio Eradication Initiative (GPEI) ramp-down, South Sudan has developed a polio transition plan complete with costing and resource mobilization plan.
Despite the challenges faced due to access and insecurity, South Sudan has maintained a good grip on its efforts to eliminate neglected tropical diseases (NTD).
Prevention and control work, including establishment of treatment centres, mass drug administration, and training of health workers in diagnostics, was implemented against NTDs such as human African trypanosomiasis (HAT), Kala-azar (visceral leishmaniasis), onchocerciasis and lymphatic filariasis. Mapping to determine endemicity of schistosomiasis and soil-transmitted helminths was also conducted in 22 counties.
To support South Sudan in its efforts to address non-communicable diseases,
WHO provided technical guidance for adaptation of the WHO Package of Essential Non-communicable Diseases Intervention (WHO-PEN) guideline. The organization also supported the revision of the essential drugs list to include medicines for hypertension and diabetes at primary health care level.
South Sudan has a huge mental health burden but limited capacity for mental health services. The country has only three practicing psychiatrists for a population of 12 million, and 12 beds for mental health located in the national referral hospital. Work is underway to address this huge gap, including expanding mental health to 14 primary health care centres (PHCCs) and general hospitals throughout the country where patient assessment, follow-up, psycho-education and basic care is ongoing.
Most of the activities of WHO’S Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH&N) programme focused on building national and subnational capacity for RMNCAH&N through training, supportive supervision, technical support and the development and adaptation of guidelines aiming to improve access and quality of care.
A strong health system is the backbone of any health intervention in a country, including prevention and treatment of diseases, immunization campaigns and response to health emergencies. WHO engaged with the South Sudan health authorities to build staff capacity, improve documentation and reporting systems, avail and adapt guidelines and templates and also support with the provision of essential equipment and supplies aiming to rebuild and strengthen South Sudan’s health system.
Availability of safe blood is key to providing optimum health care and saving lives, especially in maternal and other emergencies requiring surgical intervention or blood transfusion. In 2018, the National Blood Transfusion Services (NBTS) programme expanded to three more centres in Torit, Yambio and Rumbek aiming to achieve universal access to safe blood transfusion. A commendable increase in voluntary blood donations was also recorded in the same year.
In 2018, WHO supported the South Sudan authorities to improve preparedness and response to public health emergencies, build and strengthen capacity for emergency preparedness and response, and strengthen health emergencies information and risk assessment. The organization also continued to lead Health Cluster coordination.