PSI

In 2005 a Comprehensive Peace Agreement (CPA) was signed between South Sudan and Sudan, ending more than two decades of civil war. The Second Sudanese Civil War, 1983-2005, displaced more than four million people and destroyed much of South Sudan’s already weak physical and social infrastructure, hampered economic progress and contributed to the existing enormous deficit as regards the Millennium Development Goals 1. South Sudan’s population lives in extreme poverty - about 90% of the people live on less than US$1 a day 2and less than 30% of the children enroll in primary school, of which only 19% complete 3. Furthermore, the region has one of the world’s highest infant mortality rates, ranging from 74 per 1,000 live births for Jonglei to 151 per 100,000 live births for Western Equatoria (MDG4). Maternal mortality in the region, the highest in sub-Saharan Africa, averages over 2,000 per 100,000 live births4.

PSI/Sudan began operations in South Sudan in January 2005, distributing Serena long-lasting insecticide-treated nets (LLIN) through the commercial sector and implementing behaviour change communication on HIV/AIDS. Since then PSI Sudan has expanded operations to include a comprehensive hygiene, sanitation and safe water program in Juba, Yei and Wau; support to the Ministry of Health (MOH), Government of South Sudan, and county health departments to prevent and treat malaria; comprehensive HIV programming that includes community outreach and capacity building of Community Based Organizations (CBO’s), distribution of branded and non-branded condoms, outreach and support to people living with HIV/AIDS to mitigate the impact of opportunistic infections, and support to county AIDS commissions, the MOH and South Sudan AIDS Commission.

PSI Sudan currently distributes WaterGuard chlorine tablets for point-of-use water treatment; PUR, a point-of-use water treatment powder for water that is exceptionally turbid; Number One condoms for prevention of HIV and sexually transmitted diseases; a basic care package for people living with HIV that includes condoms, water treatment tablets and LLINs, and mass campaign delivery of LLINs. Most recently PSI Sudan has launched a child survival program that includes community education and distribution of pre-packaged treatment for malaria, diarrhoea and pneumonia, in conjunction with the Central and County MOH. PSI is Principal Recipient of a large Global Fund Malaria Grant for Round Seven.

1. 1. Source: The Millennium Development Goals (MDGs) were developed out of the eight chapters of the United Nations Millennium Declaration, signed in September 2000.
2. 2. Source: Sudan Household Health Survey, 2006, MoH.
3. 3. Source: Sudan Household Health Survey, 2006, MoH.
4. 4. Source: Sudan Household Health Survey, 2006, MoH.

Health Areas

Diarrheal Disease, HIV, Malaria

Health Impact

PSI/Sudan estimates that in 2010, its products and services helped avert:

• 3,647 HIV & TB DALYs1
• 3,544 Reproductive Health DALYs
• 309,794 Malaria Control DALYs
• 9,796 Child Survival DALYs
1. 1. Source: The DALY (Disability-Adjusted Life Year) is a widely-used, credible metric that was first developed by the World Bank and is now routinely relied upon in the public health community.

Health Interventions

• Uniformed Services Personnel
• Basic HIV Care and Prevention Package
• Male Condom
• Pneumonia Treatment

Improving Health in South Sudan

Malaria

According to patient registers, Malaria accounts for 30% of all disease cases in South Sudan with most caregivers treating Malaria at home prior to visiting a health facility. Coverage of Long Lasting Insecticide Treated Nets (LLINs) was approx. 10% in 2006 with coverage levels increasing substantially in 2008/2009 due to Nationwide Mass LLIN distribution campaigns funded by the Multi Donor Trust Fund (MDTF), the Global Fund and UNITAID.

The goal of the PSI Sudan Malaria Department is to reduce malaria related morbidity and mortality in South Sudan and to minimize the socio-economic impact of the disease. In collaboration with international and local partners, the PSI Sudan Malaria Department implements a comprehensive program to increase the availability of malaria prevention and treatment methods as well as to strengthen the capacity of the South Sudanese health system to improve the delivery of Malaria related health services.

PSI Sudan is committed to improving the quality of Malaria prevention and treatment services offered at more than 100 health facilities in Central and Western Equatoria State. Specific program activities include facilitation of consistent supply of anti-malarial and LLINs, health worker trainings on malaria case management, IPT, and the proper use of LLITNs, and strengthening capacity of the health centers to utilize Health Information System (HIS) and respond to emergencies. PSI is making a concentrated effort to ensure that the partner facilities have access to revised materials, guidelines and surveillance systems (e.g., WHO EWARN (IDSR).

In addition to facility-based activities for Malaria prevention and treatment PSI Sudan also has a comprehensive community based Malaria program. Recognizing that only 25% of people have access to health facilities in South Sudan, community based programming is essential to increase access to malaria prevention and treatment services and thereby reduce the overall burden of disease. PSI Sudan’s community-based programming includes the mass distribution of LLINs, a large scale community based HMM program and a comprehensive Behaviour Change Communication Program that includes community outreach, mid and mass media. To date PSI Sudan, the MOH and partners have distributed more than 2.2 million LLINs.

Highlight of our work

• More than 2.2 million LLINs in the first ever mass distribution campaign in South Sudan.
• Establishment of National Child Survival Guidelines and Harmonized Child Survival Training Material.
• Supporting the effort of the Ministry of Health (MoH), Government of South Sudan government through capacity building of the 703 health workers through clinical malaria training in 107 facilities.
• Capacity building support to three County Health Departments in Lainya, Yei/Morobo and Mundri through training, malaria treatment and medical supplies and monitoring tools retreated more than XX cases of Malaria (uncomplicated and complicated)
• We distributed over 300,0000 LLITN for children under five and pregnant mothers

Diarrheal Disease

Recognizing that outbreaks of Cholera and Acute Watery Diarrhea are endemic in South Sudan and that diarrheal disease is the second biggest killer of children under five, PSI Sudan operates a comprehensive hygiene, sanitation and safe water program in South Sudan. The program, which focuses on promoting household water treatment and enabling communities to adopt point-of-use (POU) water treatment and proper storage in the home, proper hand washing practices, and safe waste disposal, was initially supported by PSI, the MoH through the MDTF and is now supported by USAID through Management Science for Health (MSH). Major components of this program include:

1. The social marketing of POU water treatment products (WaterGuard and PUR)
2. Strengthening of preparedness in communities prone to outbreaks of cholera and other waterborne diseases.
3. Recognizing that children are important agents of change, PSI Sudan created the School to Community Health Initiative (SCHI), launched in late April 2007 in Yei, Central Equatoria State, and in Juba in May 2008.
4. To date, PSI community outreach officers facilitated establishment of at least one health club per school.
5. A comprehensive behaviour change communications program which includes, community outreach, health worker training programs for improved hygiene and sanitation practices, and Mass Media for demand creation and general awareness.

Highlights of our work

• In 2008 we reached 29,934 individuals through outreach/demonstrations, safe water system training for adults and students, vendor training, promotional sales events, and special communitywide events. In the first two quarters of 2009, this number is over 250,000 people.
• Working with our sales team, we sold 265,055 strips of WaterGuard chlorine tablets through private market vendors, creating 53,011,000 million litres of clean water in 2008. In the first two quarters of 2009, the WaterGuard sales reached 371,525 strips being supplemented by 294,528 sachets of PUR, providing a total of 77,250,280 liters of safe water to the community.
• Established WASH clubs in 15 schools in Juba and Yei and collaboration with 20 health facilities in Juba, Yei and Wau to provide safe water training to health practitioners and establish regular safe water awareness to patients
• A key partner of MoH/GOSS for emergency response.
• Carried out three large scale cholera prevention campaigns in cholera prone cities of Juba, Wau and Aweil reaching over 200,000 individuals with messages on health and hygiene, demonstrations of proper hand washing practices as well as POU water treatment systems – WaterGuard and PUR.
• Launched the income generating through Social Marketing Program with five CBO partners and 35 community distributors and substantially increasing communities’ access to POU water treatment products.

HIV

The HIV department aims to reduce HIV infection in South Sudan through a combination of four programs: community behavior change, distribution of the Basic Care Package (BCP), promotion of condoms through social marketing and the SPLA HIV program which targets behavior change in Sudan People Liberation Army (SPLA) uniformed services and their partners.

Highlight of our work

• In 2008, we distributed approximately 800,000 Number One condoms through the commercial sector and from January to June 2009 sold 425,556.
• Launched the Income Generation through Social Marketing (IGSM) program in partnership with the sales and MCH departments supporting the community-based sales and promotion of Number One condoms.
• Carried out the first ever private sector distribution survey in PSI locations and establishing a baseline for private sector distribution of health projects in 14 towns in South Sudan.
• Cross border technical assistance provided to the SPLA HIV/AIDS Secretariat by PSI Malawi radio trainers.
• Financial training, capacity building and direct financial support provided to 25 community-based organizations in Juba, Mundri and Tambura to provide peer education, specifically targeting youth, uniformed-services, drivers and low-income women.

Target Populations

HIV/AIDS: High risk sexually active population. Malaria: pregnant women, parents of children under five, and children under five

Latest News

• PUR Helping Southern Sudan Purify Drinking Water
  September 10, 2010
• IRIN - Sudan: Mixed success on malaria control in the south
  February 4, 2010