Southern Sudan: Contingency planning to meet the challenges of the upcoming referendum
The situation is relatively stable despite the imminence of the referendum. WHO, the Ministry of Health/ Government of Southern Sudan (MoH/GoSS) and health partners are observing the situation for possible health events – whether disease outbreaks or trauma events.
In the states bordering with North Sudan – Upper Nile, Unity, Warrap and North and West Bahr el Ghazal – the large influx of returnees is monitored by UN agencies and NGOs. Mass population returns are a concern as they could introduce diseases in areas where health facilities are already overstretched and understaffed. Around the Greater Upper Nile Region (Upper Nile and Jonglei States), an outbreak of visceral leishmaniasis (kala-azar) since September has overwhelmed many health centres and mortality rates have risen, especially among malnourished children. A sudden population increase in endemic areas could push the spread of kala-azar and undermine efforts to contain the disease. The ensuant overcrowding in transit camps would also heightened the risk of diarrhoeal diseases, measles and acute respiratory infections during the rainy season.
Two of the key challenges faced by WHO and the MoH/GoSS are:
- weak human resource capacity to mobilize trained health workers at short notice to respond to emergencies,
- limited access to medical and health supplies.
This is particularly acute as many international organizations are planning to relocate key international staff to neighbouring countries during the holidays and referendum period. This could undermine the availability and accessibility of health services, since 85% of all health services in Southern Sudan are supported and managed by international organizations.
WHO and the MoH/GoSS are fostering coordination among all health stakeholders at central and state level to fill these gaps, one of the core requirements of the overall contingency plan. This is what has been done so far:
- Training on rapid response intervention for health personnel continues at state and county level, focusing on epidemic disease control. Training on trauma management will take place once funding is secured.
- WHO provided technical support to the MoH/GoSS to activate an Emergency Preparedness and Response Committee tasked with collectivizing resources and funds at the national level, recruiting standby medical personnel with surgical skills to be deployed whenever required and procuring medical supplies.
- At the state and county level, WHO pre-positioned 15 interagency emergency health kits (IEHK) (each kit provides medicines and equipment for 10 000 people for 3 months), 14 trauma kits (each kits provides for the needs of 100 patients requiring trauma surgical care) and 12 diarrhoeal diseases kits (each kits provides treatment for 100 severe cases or 400 moderate cases). Of these, 8 trauma kits, 9 IEHK and 8 diarrhoeal diseases kits have already been prepositioned in 8 state capitals and the remaining kits will dispatched to Western Bahr el Ghazal and Eastern Equatoria shortly. A further 12 IEHK, 12 trauma kits and 13 diarrhoeal diseases kits will be distributed shortly.
- UNICEF and UNFPA are providing primary health care kits, vaccines and reproductive health kits. MSF, Medair and ICRC have agreed to conduct emergency response activities and medical interventions in the event of a humanitarian disaster or disease outbreak – MSF and ICRC have surgical capacity that can be mobilized at short notice.
- All states now have outbreak investigation supplies and 200 000 doses of meningitis vaccine are available in-country. Other vaccines available include 362 240 BCG doses against tuberculosis; 979 090 DPT doses; 2 221 160 doses of oral polio vaccine; 678 010 doses of measles vaccines (UNICEF ordered another 429 000 doses to be delivered by the end of the month), and 2 507 280 tetanus toxoid doses.
WHO headquarters and the Regional Office for the Eastern Mediterranean are consulting with the WHO Office in Southern Sudan to mobilize additional technical capacity, including technical experts and epidemiologists as well as a coordinator dedicated to the Health Cluster.
A communication mechanism, designed to integrate all health actors, including State health ministries and NGOs operating health facilities at all levels has helped strengthened effective coordination among partners.
The WHO Integrated Disease Surveillance and Response (IDSR) strategy – funded by USAID – is in place in all 10 states. Increased capacity for disease surveillance from state to county level and ability to stay mobile is a contingency resource that could prove valuable during the post-referendum period.
As of 20 December, US$ 3.1 million out of US$ 5.6 million of the funds needed in Southern Sudan had been pledged, of which US$ 2.1 had been received. For North Sudan, US$ 2.5 million out of US$ 2.7 million had pledged of which US$ 1.5 million had been received. ECHO and the Common Humanitarian Fund have provided funds to both. The graph below provides the information visually.