Decades of civil strife and insecurity left an impact on health and social services in South Sudan. It is estimated that less than 50% of people have access to basic health services. Looking at its geography, South Sudan is a landlocked country and shares international borders with six countries. In border areas people tend to travel frequently, thus increasing the risk of importing viruses from neighbouring countries. All of this makes South Sudan prone to epidemics of various diseases: from measles, over malaria, to Ebola and COVID-19.

Aware of the risks, the country has been expanding its disease surveillance and response network for more than 15 years, in support of the Integrated Disease Surveillance and Response (IDSR) strategy. During this period, it has strengthened capacities to detect, report and respond to public health emergencies. The journey is, however, not completed: old challenges are still present in areas affected by conflict and in the countryside, while new challenges emerge with new diseases, such as COVID-19.

Supported by WHO, South Sudan established the surveillance network at two levels. At the national level operate several emergency response bodies and national rapid response teams (NRRTs). Composed of interdisciplinary members, the NRRTs play an important role in investigating alerts of possible outbreaks. At the local level, there are local rapid response teams and focal points, who perform surveillance and response activities in states, counties, and health facilities. With the assistance of WHO, teams on both levels learned how to detect, report, investigate and respond to diseases. This led to faster identification and reaction to emerging threats, thus improving prevention and strengthening the public health response.. Once in place, the IDSR network was able to cover new diseases, too. In 2020 it expanded to include case definitions, alerts and action points for COVID-19 case detection, investigation and response.

As the physical surveillance network grew, a web-based early warning, alert and response system (EWARS) was taking shape, as well. Supported by WHO and other development partners, the countrywide EWARS roll out was finalized in 2019. Health workers acquired skills in data management and health facilities were equipped with gadgets like computers, smart phones, and power banks. The web-based system is especially helpful for disease surveillance in conflict-prone regions and in the countryside, where civil unrest or floods often limit essential health services’ outreach. Although it still faces difficulties, like unstable telecommunications and power cuts, EWARS keeps improving owning to the teamwork of many stakeholders. One example of this is the Emergency Preparedness and response (EPR) committee, a forum co-chaired by the Ministry of Health and WHO, whose members meet regularly to discuss trends and ways to prevent and respond to outbreaks and other public health emergencies.  

IDSR gradually grew and is currently used in all 10 states and three administrative areas; 80 counties and 1221 health facilities in South Sudan. In stable areas, where the IDSR network is functional, the share of health facilities that submitted surveillance reports reached 90% in 2020. Similarly, the share of EWARS reports from health facilities serving internally displaced people grew from 72.5% in 2019 to 81% in 2020.

With improvements in disease surveillance, South Sudan makes a firm step forward in protecting the people from health emergencies. As new diseases emerge, systems adjust to effectively respond to them. Together with the Government, partners and donors, WHO remains a committed ally along this journey.

Photo caption: Full scale EVD simulation exercise to test and validate capacities for early detection, rapid response and coordination.

Photo credit: WHO

DISCLAIMER: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.