Strengthening routine immunization in Sudan

April 2013

Sudan has reached more than 90% of children with routine immunization thanks to a committed government plan and partner support.

Reaching the hard-to-reach

In a country plagued by internal conflict and where one in ten people belong to a nomadic tribe, ensuring all children receive life-saving vaccines can be a challenge.

Dr Bashir Tahir, WHO polio medical officer, at a temporary vaccination clinic for nomadic people in Gedarif State, Sudan.
WHO & Ministry of Health Sudan

Ten years ago, around one third of Sudan’s children missed out on vaccinations against diseases such as polio, measles and tetanus, putting them at serious risk of death and disability. In one state, South Kordofan, more than half of the children were not reached by vaccination services.

Now, thanks to a committed plan by the Ministry of Health, supported by WHO, UNICEF, GAVI and other partners, more than 90% of Sudan’s children are vaccinated against diseases including polio, diphtheria, tetanus, pertussis (better known as whooping cough), and tuberculosis.

Overcoming insecurity

“The biggest challenge we face is insecurity in the Darfur region but we are keen to ensure vaccination for all so we work hard to reach every child in Sudan,” says volunteer Khadija during a polio vaccination campaign.

“From the beginning, WHO, UNICEF and the Ministry of Health worked together as a team. Sudan could not have done this alone.”

Dr Eltayeb Elfakki, WHO's Regional Office for the Eastern Mediterranean in Cairo

Access for vaccination teams in these areas is difficult and risky but the continued cooperative efforts between the government, armed groups, local communities, nongovernmental organizations, United Nations agencies and the African Union/UN Hybrid operation in Darfur (UNAMID) make exceptions to the rules of war “because it’s for the children”, says Dr Salah Haithami, from WHO’s office in Sudan. In areas of high-risk, he explains, vaccination teams use a “hit and run” strategy to enter the area under military protection, immunize the children and leave as soon as possible.

The government has also allowed volunteers from the armed-conflict areas to travel to government-controlled areas for training, providing them with vaccines and other support so that they can go back and vaccinate the children in areas where it is too risky to send in a team of outsiders.

Tracking the paths of nomads

Unloading supplies for a “hit and run” vaccination in a rebel-controlled area in North Darfur, Sudan.
WHO & Ministry of Health Sudan

The other challenge for vaccinators is reaching the 10% of Sudan’s population who belong to nomadic pastoralist tribes. By training volunteer vaccinators from the tribes, Sudan’s Expanded Programme on Immunization (EPI) has managed to reach around 80% of their children.

“We have designated a focal person in each tribe and developed maps to show their locations and movement paths as they follow the rainfall patterns to feed their grazing animals during the dry and rainy seasons,” says Dr Eltayeb Elfakki, former EPI manager at the Ministry of Health Sudan from 2001-2008, now working for WHO in its Regional Office of the Eastern Mediterranean in Cairo. The rapid spread of mobile phones among the nomads helps the EPI to keep in contact with the tribes and plan the location and timing of its temporary vaccination clinics.

Since 2002, Sudan’s EPI has doubled the number of temporary vaccination clinics from around 2000 to more than 4000.

“Whenever the tribes pass near a vaccination post, they can collect more vaccines and we can update our records,” he says.

Success all round

As well as remaining polio-free since 2009, Sudan has reduced hepatitis B among children aged less than five from 20% to 0.4% and is actively planning high quality measles campaigns to address remaining gaps in immunity.

The programme owes its success to strong commitment from the government. Other factors include a concerted effort to train health workers to fill the large human resources gap and the establishment of strong incentives (including education) to encourage staff retention. WHO, UNICEF and the GAVI Alliance have all provided technical or financial support.

“From the beginning, WHO, UNICEF and the Ministry of Health worked together as a team,” says Elfakki. “Sudan could not have done this alone”.