South Sudan is a landlocked country in Eastern Central Africa, home to more than 12.5 million people and in 2018 has been classified as the most fragile state in the world, according to the Fragile States Index. Some of the many reasons for this fragility include armed conflict, inter-communal violence, economic decline, disease, and climate shocks, resulting in some of the world’s poorest health and development indicators.
From December 2013, after only two years of independence, up to August 2018, when a peace agreement was signed between the many warring parties, South Sudan had remained locked in conflict. The severity of the crisis has led to thousands of lives being lost directly through fighting and indirectly through disease (among other causes).
Since the outbreak of the crisis, 4.1 million people have become displaced, including 2.2 million who have fled to neighbouring countries, leaving 1.9 million others internally displaced. This has resulted in a nation that is now suffering from severe hunger and malnutrition, with one in three children characterised as acutely malnourished and 6.4 million people living with severe food insecurity.
South Sudan - Public Health Crisis
South Sudan is experiencing a public health crisis. It suffers from a heavy burden of malaria, which is made worse by violence and displacement. Displaced people are particularly vulnerable to communicable diseases, as exemplified by the increase in malaria outbreaks in recent years, in particular in the country’s camps for internally displaced persons (IDP), the Protection of Citizen Camps (PoCs) as well as refugee camps. Malaria has crippled more communities across the country than any other. With an estimated number of 1.8 million cases and more than 6,000 deaths in 2017 it remains the top public health priority in South Sudan. Other tropical diseases taking their toll on the health of South Sudan’s population include diarrhoeal diseases, Onchocerciasis (River Blindness), Lymphatic Filariasis, Visceral Leishmaniasis, Schistosomiasis, Soil-Transmitted Helminths, Trachoma and others.
The MENTOR Initiative aligns its approach with the WHO Integrated Vector Management (IVM) strategy and effective malaria case management.
The IVM package combines vector breeding site reduction and control (with WASH activities focused on surface water treatment, hard and soft waste management, and behaviour change) as well as direct protection from infection, through the implementation of:
- Indoor Residual Spraying (IRS): Interior walls of human and animal shelters are sprayed with insecticide to ensure 6-9 months of control of malarial mosquitoes and other household insects.
- Larviciding (Larval Source Management): Regular treatment of open surface water in the camps that otherwise provides a breeding site for malaria (Anopheles) mosquitoes and containerized water (drums, used tyres etc.), the preferred breeding site for mosquitoes (Aedes) that are capable of transmitting Dengue, Chikungunya and Yellow Fever.
- Fly Control: Regular treatment of potential fly breeding sites, such as pit latrines, waste disposal sites, animal manure and open defecation sites to curb the adult fly population in an effort to prevent fly-borne diseases.
- Medical Commodities: MENTOR supplies health facilities in its operational areas with medical commodities like Rapid Diagnostic Tests (RDTs) for diseases such as malaria, leishmaniasis, dengue fever and others, malaria drugs for treatment and prevention (in pregnancy) of malaria, syringes and more. Donations of medical commodities happen on a gap-filling basis to prevent stock-outs.
- Information, Education, and Communication (IEC) messaging: Teaching safe vector-borne disease practices and how to prevent contracting the diseases. Examples are the use of Long-Lasting Insecticidal Nets (LLINs), avoiding creating mosquito breeding sites, recognising disease symptoms and seeking early treatment as well as going for regular Antenatal Care (ANC) check-ups during pregnancy.
- WASH Activities: The MENTOR Initiative implements hygiene promotion activities in targeted areas to increase community awareness and knowledge around inadequate hygiene practices whilst interactively guiding through feasible, realistic and effective behaviour change to prevent water-borne diseases.
- Mass Drug Administration (MDA): The MENTOR Initiative has so far implemented two MDA campaigns in South Sudan. MDA is a means of delivering essential medicines based on the principles of preventive chemotherapy. Populations are offered treatment without any individual diagnosis taking place beforehand. The aim is to prevent and alleviate symptoms and morbidity and to also reduce disease transmission. MDA is the recommended strategy of the World Health Organization to control or eliminate several neglected tropical diseases (NTDs).
MENTOR in South Sudan
The MENTOR Initiative began partnering with the Government of South Sudan and its country partnership of the United Nations (UN), Non-Governmental Organizations (NGOs) as well as Faith-Based Organizations (FBOs) in 2012, in order to find effective, timely and scalable solutions to vector-borne disease control. Efforts have been made to reduce the heavy burden of malarial and other vector-borne diseases amongst the most vulnerable displaced and isolated communities affected by conflict, displacement, malnutrition and flooding, while also working to mitigate the risk and impact of disease epidemics. To date, MENTOR has focused support on communities in Warrap, Abeyi, Northern Bahr el Ghazal, Upper Nile, Lakes and Unity states.
Bentiu PoC, Rubkona- Former Unity State
The MENTOR IRS campaign, supported by UNICEF, for 2018 in Bentiu PoC was completed in August, reaching a total of 117,204 internally displaced persons. IRS sprayers are also accompanied by mobilizers, who are tasked to educate households on preventing and controlling malaria through the proper use of mosquito nets, the signs and symptoms of malaria and treatment-seeking behaviour. MENTOR also treats mosquito breeding sites as part of its Larval Source Management (LSM) campaigns on a regular basis as well as potential fly breeding sites. To determine the impact the activities, have on the local mosquito population, a number of entomological sentinel sites routinely collect data on key entomological parameters, such as mosquito population density, the predominant mosquito species as well as mosquito resting and biting behaviours.
Malakal PoC, Former Upper Nile State
The 2018 MENTOR IRS campaign in Malakal PoC, also supported by UNICEF, was completed in July, reaching a total of 28,372 IDPs. IRS sprayers are also accompanied by mobilizers, who deliver VBD IEC messages to all households.
As in Bentiu PoC, MENTOR also treats mosquito breeding sites as part of its LSM campaigns on a regular basis as well as potential fly breeding sites. Several entomological sentinel sites also collect data on key entomological data, such as mosquito population density, predominant mosquito species as well as mosquito resting and biting behaviours.
Maban County, former Upper Nile State
The MENTOR Initiative has been active in Maban since 2013 and implements VBD control activities in all four refugee camps in the county. As of 2019, all camps combined are temporarily home to over 146,000 refugees, which have fled violent conflicts in the border region of South Sudan and Sudan.
MENTOR’s yearly IRS campaigns, supported by the United States’ Bureau of Population, Refugees, and Migration, target every shelter in the camps, just before the yearly rains start, to protect people throughout the malaria high-transmission season. IRS in Maban also protects people from sandflies, which transmit Visceral Leishmaniasis, a disease that is highly endemic in this region of the country.
MENTOR also regularly carries out LSM and fly control activities. These activities are complemented by IEC sessions in the camps, whereby refugees are invited to learn about malaria and other VBDs, how to prevent them, signs and symptoms and when and where to seek treatment. The refugees can then pass the information and messages on to their family and relatives, resulting in a multiplication effect.
Furthermore, training and technical coaching is being provided to health care providers and managers/supervisors from health facilities in and around the camps on malaria and other VBD diagnosis as well as correct treatment of diagnosed diseases. Additionally, MENTOR also supplies medical commodities to these health facilities to prevent them from experiencing episodes of stock-outs and the subsequent inability to correctly diagnose and treat tropical diseases.
Jamjang County, Ruweng State
In Jamjang County, MENTOR is active in two refugee camps since 2018: Pamir and Ajoung Thok. Like in Maban, the programme is supported by the United States’ Bureau of Population, Refugees, and Migration. The yearly IRS campaign targets both camps and protects over 65,000 refugees from disease-transmitting mosquitoes, which thrive during and after the rainy season as the result of an abundance of breeding sites. IRS in Jamjang also protects people from sandflies, which transmit Visceral Leishmaniasis, a disease that is endemic in the state.
In addition, MENTOR carries out LSM and fly control activities in the two camps as well as IEC sessions on malaria and other VBDs, how to prevent them, signs and symptoms and when and where to seek treatment. In Jamjang, MENTOR also disseminates health- and VBD-related information though radio shows.
Training and technical coaching is also being provided to health care providers and managers/supervisors from health facilities in and around the camps on malaria and other VBD diagnosis as well as correct treatment of diagnosed diseases. Additionally, MENTOR also supplies medical commodities to these health facilities to prevent them from experiencing episodes of stock-outs and the subsequent inability to correctly diagnose and treat tropical diseases.
Aweil East, Northern Bahr el Ghazal
In Aweil, MENTOR is involved in community hygiene promotion activities to reduce water-washed and water-borne diseases amongst the most vulnerable communities. Hygiene promotion activities increase community awareness and knowledge around inadequate hygiene practices whilst interactively guiding through feasible, realistic and effective behaviour changes. A list of community-based hygiene promotional approaches is applied to reach different levels of community structures with emphasis placed on household reach through door-to-door messaging and community hygiene sensitization meetings. Besides the community Health Promotion interventions, institutional hygiene promotion is also being conducted at health and education facilities, e.g. children at schools and mothers with malnourished children at an outpatient therapeutic feedings centre and peripheral health facilities.
Western Equatoria State
In 2018 in the state of Western Equatoria, the MENTOR Initiative implemented the second Mass Drug Administration campaign since 2017. Onchocerciasis and Lymphatic Filariasis were the targeted diseases, using a combination of two different drugs. The campaign was supported by Sightsavers and the END Fund.
Despite ongoing fighting and displacement of populations, the MENTOR team managed to distribute the drugs to 562,561 people to treat and prevent both diseases, which can, among a multitude of symptoms, lead to permanent blindness and severe bodily disfigurement.
The Way Forward
MENTOR remains committed to delivering health as well as VBD control and prevention services to the most vulnerable populations in different regions of South Sudan. With the security situation remaining fragile even despite the signed peace agreement, internal displacement is estimated to remain high. Neighbouring countries like Sudan, the Democratic Republic of the Congo and the Central African Republic experience political turmoil, with armed conflicts and ethnical clashes leading to people fleeing to South Sudanese territory and temporarily settling into makeshift camps. The country remains endemic for a multitude of tropical diseases, which can thrive in displacement settings. MENTOR will therefore seek to continue its current activities to reduce deaths and suffering from tropical diseases in South Sudan.
Page last updated 09/05/2019