Preventive Health

The Directorate of Preventive Health Services is responsible for the coordination and management of programmes, projects and responses to control endemic diseases, non-communicable diseases and neglected tropical diseases. It develops and provides policies, guidance, protocols and standards to address these conditions. The Directorate comprises a number of Departments which correspond to different activities and programmes it undertakes.

Malaria Control Programme

Malaria remains a leading cause of mortality in South Sudan.  It accounts for almost a quarter (24.7%)[1] of all diagnoses reported by health facilities in South Sudan. According to the 2009 South Sudan Malaria Indicator Survey (SSMIS), up to 35% of children below five years had suffered from a fever within the two weeks preceding the survey. Only 12% of children with fever were treated with an appropriate anti-malarial medicine within twenty-four hours of the onset of fever. Although 53%[2]of households have one or more insecticide-treated nets (ITNs), only 25% of children under five and 36% of pregnant women sleep under an ITN.   The socioeconomic burden of malaria is thought to be very high. In 2011, August, September and October witnessed an unprecedented increase of malaria morbidity and mortality across South Sudan.

The Malaria Control Programme’s main interventions are early case detection, management and distribution of bed nets through routine health services and community mass campaigns.

Sources: [1] UNICEF, 2009; [2] South Sudan Malaria Indicator Survey 2009.
Recent activities include:
  • Conducting Malaria Programme Review to identify strengths and weaknesses in collaboration with partners.
  • Supplying anti-malarial (ACT) drugs
  • Strengthening partnerships at national, state and county levels on malaria control.
  • Promoting behavioural change through communication and social mobilisation.
  • Recruiting state malaria M&E officers.
  • Improving coordination with Health Management Information System and Integrated Disease Surveillance and Response.
  • Supplying ten vehicles to the states for malaria surveillance purposes.
  • Indoor residual spraying (IRS) pilot programme in Warrap and Malakal in partnership with the Mentor Initiative (an NGO).
  • National conference on vector control held in October 2012.
  • Distributing over two million long-lasting insecticides treated mosquito nets through campaigns in Warrap, Western Bahr al-Ghazal and Western Equatoria.
  • Updating malaria treatment protocol according to WHO guidelines.
  • Conduct the national Malaria Indicator survey 2013

Planned activities include:

  • Provide prompt diagnosis and treatment of malaria; improve access to free malaria diagnosis and treatment.
  • Scale-up the distribution of long-lasting insecticide treated mosquito nets (LLITN) to the community through mass campaigns in a three-year phased effort.
  • Update the national Malaria Control strategic plan for 2014-2018
  • Strengthen the vector control unit of the malaria control programme.
  • Conduct a vector mapping and susceptibility study
  • Introduce an integrated vector management approach for the Republic of South Sudan, (IRS, LLITN, larviciding, environmental management).
  • Promote environmental management through health education.
  • Provide a complete package for management of malaria in pregnancy (IPT, LLITN, prompt treatment with ACT).
  • Strengthen the malaria epidemic preparedness and response capacity.
  • Provide a comprehensive package for behaviour change, communication and advocacy.
  • M&E: conduct research studies in malaria and strengthen malaria disease surveillance (MIS, sentinel sites, TET, vector mapping and susceptibility study, support supervision visits).
  • Strengthen programme management policies, guidelines; improve partnership coordination and recruit staff to key positions in the malaria control programme.
  • M&E: conduct research studies in malaria and strengthen malaria disease surveillance (MIS, sentinel sites, TET, vector mapping and susceptibility study, support supervision visits).
  • Strengthen programme management policies, guidelines; improve partnership coordination and recruit staff to key positions in the malaria control programme.

Current activities include:

  • The NMCP with support of partners, PSI, Malaria Consortium, WHO, USAID, UNICEF, National Bureau of Statistic, and others is currently conducting the 2nd Malaria Indicator Survey.
  • NMCP is also undertaking an anti malaria drug efficacy study in Kator PHCC of juba County, Central Equatoria State.

HIV/AIDS/STIs

The prevalence of HIV/AIDS in South Sudan is estimated at 3%[1], with the epidemic considered to be low generalised, though with some areas observed to have much higher prevalence, especially Western Equatoria State. Only 8.9% of those eligible for treatment are currently accessing it. The prevalence is expected to increase, mainly due to the low level of knowledge about HIV/AIDS and the practice of high-risk behaviours.

Recent activities to address HIV/AIDS include:

  • Twenty-two anti-retroviral therapy (ART) treatment centres in South Sudan taking care of about ten thousand clients with over four thousand on ART.
  • Establishing seventy-five prevention of mother to child transmission (PMTCT) facilities, of which fifty PMTCT sites provide comprehensive services and twenty-five currently provide only testing facilities, with patients referred to treatment sites if necessary. The programme has established over one hundred and twelve HIV testing and counselling (HTC) sites. All facilities are integrated into existing health care structures.
  • Realising supplies of ART drugs sufficient for HIV/AIDS patients in South Sudan. These supplies are not sufficient to cover newly diagnosed cases.
Sources: [1] 2009 Antenatal Care Surveillance Report.
Planned actions to address HIV/AIDS:
  • Review of HIV Guidelines to support up-to-date implementation of HIV services as an integral package of BPHS.
  • Increase national and stakeholders funding for HIV by 40%.
  • Establish and support HIV/TB Coordination mechanism at state and county level.
  • Establish Coordination mechanism at National level: National HIV/TB Health sector review meeting.
  • Develop simple package on talking points (fact sheets) on HIV and AIDS for SMoHs and County leaders.
  • Conduct annual training of trainers (ToT) on leadership and management of HIV programs at both national and state levels.
  • Conduct bi -annual quantification and forecasting of HIV commodities and supplies.
  • Procure HIV commodities and supplies, and stock the central medical stores.
  • Establish supply chain management to deliver ARVs and other HIV commodities from the central medical stores to the ART facilities in a timely manner.
  • Print and distribute 5,000,000 HIV/STIs IEC materials. PMTCT, CT, condoms, ART, patient education and HIV/AIDS Behaviour change materials.
  • Support provision of clinic educational sessions to all mothers attending ANC on the importance of PMTCT and the value of male involvement.
  • Establish a referral and follow-up system for HIV exposed infants and provide transport for mothers to PMTCT sites or DBS supplies and transport of samples.
  • Training of service providers on early infant diagnosis using PCR machines.
  • Conduct training of HCPs in Basic IMAI.
  • Conduct training on laboratory monitoring: CD4, chemistry, haematology. Training for two persons for new sites annually and annual refresher training for two persons per site for the old sites.
Tuberculosis, Leprosy and Buruli Ulcer

A resurgence of tuberculosis (TB) has been reported globally. Although TB is thought to be among the major causes of morbidity and mortality in South Sudan, there are limited data on the TB burden. However, there has been a steady increase in TB notification from 53/100,000 in 2008 to 85/100,000 in 2011. The prevalence of HIV among TB patients has reached epidemic proportions (15%, in the 2011 TB/HIV survey report). Coverage of TB services in the country is still low (1 lab/137,000 people against a WHO target of 1 /50-100,000) with limited community involvement in TB care.

Whereas, the number of new leprosy cases detected has been gradually reducing worldwide, South Sudan is registering an increasing trend of new cases in the last five years (599 cases in 2008 to 1500 cases in 2011).

Recent activities include:

  • Increasing the number of health facilities providing TB services (diagnostic and treatment centres) from thirty-two in 2006 to sixty-five in 2012.
  • Maintaining a treatment success rate above 75% despite an increase in notifications of over 50%.
  • Increasing human resource capacity from only one staff member in 2009 to twenty-four in 2012, fourteen at national level and ten state-level coordinators.
  • Developing a five year TB strategic plan
  • Implementing a centralised recording and reporting system.
  • Ensuring uninterrupted supply of quality-assured drugs throughout the country.

Planned actions include:

TB Control
  • Strengthen and expand quality diagnostic TB services through integration into the PHC system. The MoH plans to have at least one health facility providing diagnosis and treatment of TB in each county.
  • Encourage patient compliance with TB treatment with the aim of achieving and maintaining a treatment success rate of at least 85%.  The programme also intends to promote the use of community TB treatment supporters to reduce defaulting.
  • Strengthen human resource capacity for TB control. The MoH intends to recruit and retain seventy-nine TB county coordinators.
  • Strengthen programme supervision, monitoring and evaluation. The MoH intends to achieve this through coordination meetings at all levels, timely reporting and programme review and evaluation.
  • Scale up integrated TB/HIV services through strengthening of collaboration between the TB and HIV programmes, train staff on collaborative activities and roll out job aids and Standard Operating Procedures (SOPs).
  • Prevent, monitor and effectively manage Multi-Drug Resistant/Extremely Drug Resistant TB (MDR/XDR-TB) in South Sudan. The MoH intends to establish mechanisms to regulate the prescription and dispensation of TB drugs in South Sudan.
  • Renovate TB treatment facilities.

Leprosy Control

  • Raise community awareness to aid early detection, contact tracing and reporting for treatment.
  • Increase the number of facilities to improve timely case finding and thus reduce the disease burden by early treatment.
  • Promote and strengthen approaches to extend leprosy control services to as-yet uncovered and difficult to access areas, and those where a high proportion of new cases with Grade 2 disabilities and cases affecting children have been detected.
  • Monitor progress by considering the trend of new cases with Grade 2 disabilities in the population.
  • Prevent and manage disabilities due to leprosy.
  • Promote social welfare and community-based rehabilitation of people affected by leprosy.

Buruli Ulcer Control

Due to appropriate treatment and sanitation activities, Buruli ulcer has been steadily declining in South Sudan, it is currently localised to Northern Bahr el-Ghazar and Western Equatoria. In 2012, only three cases were identified in the whole country. To continue efforts to eradicate Buuruli Ulcer completely it is planned to further promote the integrated disease surveillance and response system.
Non-Communicable Diseases Control
Low and middle-income countries suffer the greatest impact of non-communicable diseases (NCDs) such as diabetes, hypertension, cancer and ischemic heart disease. These are reported to account for up to 20% of all deaths in Sub-Saharan Africa.  Increases in the incidence of diabetes and hypertension are particularly alarming.
Source: Unwin et al., 1999.
Planned actions include:
  • Carry out Step Wise Surveillance of NCDs.
  • Reduce major risk factors (alcohol and tobacco consumption) through regulation and raising public awareness.
  • Strengthen the capacity of health personnel, institutions and other stakeholders to identify major risk factors.
  • Improve the prevention and management of NCDs through standard guidelines and protocols for all levels of healthcare.
  • Promote healthy lifestyles in communities, especially among high-risk individuals.
  • Promote public awareness campaigns about the major risk factors for NCDs.

Neglected Tropical Diseases Control

South Sudan suffers a high burden of several neglected tropical diseases (NTDs), which include kala-azar (visceral leishmaniasis), human African trypanosomiasis, trachoma, Buruli ulcer, leprosy, common intestinal worms (soil-transmitted helminths), elephantiasis (lymphatic filariasis), loasis, river blindness (onchocerciasis), nodding syndrome, Guinea worm (dracunculiasis) and bilharzia (schistosomiasis).

In South Sudan, a number of successful NTD control programmes have been launched since the CPA, targeting onchocerciasis, with support from Africa Programme for Onchocerciasis Control (APOC); and dracunculiasis and trachoma, with support from the Carter Center.  The onchocerciasis and dracunculiasis control programmes provide good examples of disease-specific interventions for at-risk populations. The MoH is in the process of integrating these various interventions.

Recent activities include:

  • Developing a comprehensive plan of action for the Integrated Disease Surveillance Programme.
  • Holding a meningitis preparedness workshop for the ten states.
  • Reviewing, producing and disseminating IDSR surveillance tools to the ten states.
  • Assessing surveillance activities on Guinea worm interrupted transmission zones.
  • Providing diagnosis and treatment of visceral leishmaniasis at twenty-six VL treatment centres.
  • Providing diagnosis and treatment of human African trypanosomiasis at seven HAT treatment centres.
  • Reviewing VL and HAT diagnosis and treatment guidelines.
  • Devising action plan for trachoma, endorsed by the MoH.

Planned actions include:

  • Review integrated NTDs strategy.
  • Conduct baseline survey on nodding syndrome.
  • Re-launch onchocerciasis control programme.
  • Advocate and mobilise for prevention and control of NTDs at community-level; IEC materials, BCC campaigns.
  • Strengthen surveillance for NTDs at all levels, especially at community-level.
  • Expand access to treatment and control of NTDs through community based mass drug administration.
  • Expand vector control programmes for NTDs.
  • Build capacity of communities and schools for NTD control.
Guinea Worm Eradication Programme

South Sudan accounted for 97% of all Guinea worm cases reported globally in 2011. During the period 2006-2011, South Sudan maintained steady progress and reduced Guinea worm cases by 95%. The number of Guinea worm endemic villages was reduced by 90%. The MoH sustained this progress with support from the Carter Center, and other development partners.

The Republic of South Sudan is committed to the global eradication campaign and endeavours to achieve complete interruption of transmission by 2013. This is in line with the 1997 World Health Assembly resolution that urged all member states to continue to ensure political support and resources for completion of eradication of Guinea worm disease as quickly as technically feasible.

The major functions of the department include:

  • Supporting surveillance for Guinea worm cases by village volunteers.
  • Case management, including occlusive bandaging.
  • Distribution and replacement of filters.
  • Abate application to treatable water sources.
  • Health education.

The planned actions for the department include:

  • Train village volunteers, field officers and programme officers.
  • Procure and deliver intervention materials.
  • Conduct state-level midterm review meetings of the Guinea worm eradication programme’s (GWEP) activities.
  • Commission an external evaluation of GWEP activities in endemic and formerly endemic states.
  • Conduct regular assessments of surveillance activities in endemic counties.
  • Train health workers from the SPLA medical corps on surveillance of Guinea worm disease with support from WHO, including a sensitisation workshop in Upper Nile.
  • Conduct monthly meetings of the GWEP taskforce.
  • Organise visit by the taskforce to endemic villages.
  • Conduct annual programme review meetings.
  • Participate in cross-border collaboration with neighbouring countries.
Environmental and Occupational Health
Environmental health deals with water and sanitation, chemical waste (including pesticides), solid waste, liquid waste, medical waste, air pollution, and food safety. Occupational health promotes and maintains the physical, mental and social well-being of people at work.
Recent activities include:
  • Environmental Health Assessment – July 2011, funded by WHO.
  • Developing the Healthcare Waste Management Plan 2012-2016.
  • Procuring six medical incinerators and ten waste containers through UNDP.

Planned actions include:

  • Develop national strategic plans for environmental health (air pollution, water quality, and chemical waste).
  • Implement Healthcare Waste Management Plan.
  • Develop national policies, guidelines and plans for health at work.
  • Establish support services for occupational health.
  • Develop occupational health standards based on risk assessments.
  • Recruit staff for occupational health.
  • Develop information services to effectively transmit data.
  • Raise public awareness through public information campaigns.
  • Conduct occupational health research.
  • Coordinate occupational health with other activities and services.
  • Procure heavy-duty incinerators for medical waste.
Epidemics Preparedness & Response

Communicable diseases contribute to proportionately higher population morbidity and mortality rates in South Sudan than other countries in the Horn of Africa. All the epidemic prone diseases, including cholera, measles, polio, meningitis, viral haemorrhagic fevers (Ebola, yellow fever, dengue fever), among others, have occurred in South Sudan since 2000.

Disease outbreaks, sometimes simultaneous, are frequent. During the January 2007 – October 2008 period, major outbreaks of meningitis, cholera, measles, and hepatitis E have occurred simultaneously, and in the same locations.

South Sudan lies within the “African meningitis belt” and continues to experience recurrent outbreaks of meningitis. Meningococcal meningitis outbreaks consecutively hit South Sudan in 2006 and 2007. During the 2007 season, South Sudan with over twelve-thousand cases and six hundred deaths was only second to Burkina Faso in terms of the most affected countries in the African meningitis belt. Nesseria meningitis serogroup A was identified as the prevalent strain of the two outbreaks. Currently, there is an ongoing outbreak of hepatitis E in refugee camps in Maban County.

Planned actions include:

  •    Mobilise stakeholders on emergency preparedness and response activities.
  •    Develop and update protocols and guidelines for epidemic prone diseases.
  •    Improve emergency preparedness and response capacity of medical staff to respond to public health emergencies.
  •    Develop a national framework for surveillance integration to guide the process of integrating AFP and GW into IDSR program.
  •    Procure and preposition emergency medical supplies, vaccines, diagnostic kits, specimen collection materials and reagents, personal protective equipment (PPE) as required to various levels.
  •    Improve early detection, rapid confirmation and timely laboratory results feedback for priority epidemic diseases.
  •    Continue to expand the integrated disease surveillance (IDS) reporting sites to newly opened health facilities.
  •    Roll out community based IDSR surveillance.
  •    Assess the current IDSR system and implement international health regulations.
  •    Continue with in service capacity building for the surveillance officers and rapid response teams.
  •    Update case definitions and produce tools for priority diseases surveillance.
  •    Procure communication assets and distribute to surveillance officers.
  •    Recruit staff to key positions.

 

Contacts:
Director General,
Dr. Pinyi Nyimol Mawien
Email: pinyiubur@yahoo.com
Tel: +211(0) 955604020