No Matter the Challenge, Net Distribution in South Sudan Goes On

By Bojo Samuel, Deputy Program Director, PSI South Sudan, and Kathryn Malhotra, Malaria Technical Advisor, PSI

“We’re here to ensure that every household receives a long-lasting insecticide-treated net…now and not later.” – Samuel Amet, Representative of the Country Coordinating Mechanisms (CCM) in South Sudan

With financial backing from the Global Fund, PSI has been collaborating with the Republic of South Sudan’s Ministry of Health, the Country Coordinating Mechanisms (CCM) and the National Malaria Control Program (NMCP) since January 2018 to distribute insecticide-treated nets (ITNs)—which play a crucial role in malaria vector control—as part of mass campaigns to protect South Sudan’s population from the spread of malaria.

Obstacles to net distribution during these mass campaigns are nothing new in South Sudan; the country has historically faced prolonged flooding and political unrest, which make it difficult to distribute nets where and when they are needed. But the onset of COVID-19 created an additional challenge, and the program needed to adapt—and quickly. Local leaders were especially motivated for the ITNs to be distributed before the peak rainy season, which usually begins in June, was in full swing.

In South Sudan’s Northern Bahr el Ghazal State (NBeG), the first mass campaign in 2020 launched on March 10th and needed to adapt its distribution methods quickly as COVID became an issue on both a global and national scale. With their prior experience, the PSI South Sudan team and its partner, Malaria Consortium, identified four strategies that would allow net distribution campaigns to continue through the COVID-19 pandemic with minimal interruption:

    1. Adequate planning by stakeholders at multiple levels of the health system, especially at the community level.
    2. Adaptive implementation of campaign approaches using new COVID guidance from WHO and global guidance from the Alliance for Malaria Prevention, both adapted to South Sudan’s context by the country’s government.
    3. Effective communication and coordination of field operations.
    4. Adapting to new population projections by using them to estimate the number of ITNs needed and building creative new ways to distribute them during the pandemic.

Learn more about each strategy below.

Adequate Planning

Planning meetings were conducted between key stakeholders at both the state and county levels of Northern Bahr el Ghazal, aiming to obtain political support from state ministries, county authorities, community leaders and religious leaders.

This high level of engagement translated to strong support and ownership of the campaign for all stakeholders involved. For example, leadership at the NBeG state-level directed all security agencies to provide protection services for distribution teams and the stock of ITNs. At the same time, chiefs at the local level proactively identified volunteers, acted as mobilizers, identified distribution sites and provided security for the nets in storage facilities.

Adaptive Implementation

The program team has navigated many challenges while distributing nets. But for every challenge faced, a lesson was learned, so they were well prepared to face COVID’s challenges head-on and adapt to them quickly.

Clients wait to wash hands while maintaining physical distancing before receiving ITNs at the fixed distribution point in Aweil South County. Credit: Kaya George, PSI South Sudan
Clients wait to wash hands while maintaining physical distancing before receiving ITNs at the fixed distribution point in Aweil South County. Credit: Kaya George, PSI South Sudan

Mid-way through the campaign in late March, the government of South Sudan imposed a nationwide lockdown including restricted movement and limits on social gatherings to curb the spread of COVID-19. With guidance from the Ministry of Health and the High-Level Task Force for COVID-19, the team continued the campaign while implementing stringent preventive measures including adhering to physical distancing during trainings and net distribution activities, regular and thorough handwashing and no hand-shaking or hugging. Chalk was used to mark recommended distances for physical spacing at the distribution sites. At the time of the campaign, additional Personal Protective Equipment like masks and hand sanitizer were not available. The team also delivered targeted health education sessions using informational materials adapted into the local language, Dinka. There were groups of monitoring teams that were out during the campaign to monitor that the distribution teams were adhering to the new COVID adaptations.

Effective Communication and Coordination

During the campaign, operations in each county were implemented in three tiers: county level, Payam-level (the second-lowest administrative division in South Sudan, with a minimum population of 25,000) and Boma-level (the lowest-level administrative division, made up of various villages). A county task force led by a County Technical Officer was responsible for the selection of distribution sites, recruitment of volunteers and identification of storage facilities. At the Payam and Boma levels, a team led by a Payam supervisor and site manager(s) were responsible for overseeing volunteer trainings, social mobilizations, household registration, net distribution, mop (clean-up) of activities and accountability for the number of nets distributed.

COVID taskforce from MOH interacting with ITN staff in Aweil North County on a monitoring visit. Credit: Samuel Bojo, PSI South Sudan
COVID taskforce from MOH interacting with ITN staff in Aweil North County on a monitoring visit. Credit: Samuel Bojo, PSI South Sudan

PSI, CCM, NMCP and the Ministry of Health conducted regular visits to the county teams to provide oversight as well as technical and operational support. During county visits, the supervisory team held meetings with the county task force and field teams to identify and resolve key challenges to distribution. To ensure effective communication among team members in each county, a WhatsApp group called ‘’NBeG campaign 2020’’ was created for the teams to share daily field updates including key achievements, challenges and solutions with the larger distribution team.

For example, during county visits, the supervision team held meetings with the county task force and field teams, identified and resolved key challenges such as inflation of numbers, conflicts of interest in the selection of volunteers and distribution sites, safety and security of field teams and nets in store.

’If you know, you know; a net, as simple as it is, can put an elephant to its knees. And so, this campaign can put us on our knees if we don’t work hard to overcome the challenges we face.’’–Tamaba Gbore, Malaria Consortium Field Coordinator

‘’We have to face the challenges of the campaign as a team and not as individuals or organizations; Whether we are from PSI, CCM, NMCP, the South Sudan Ministry of Health or the Malaria Consortium, we are one team with the ultimate goal of making this campaign a success.” –Saul Kidde, PSI Program Director

A client receives ITNs for her household while maintaining physical distancing in Aweil South County, South Sudan. Credit: Samuel Bojo

Adapting to Population Projections

The South Sudan National Bureau of Statistics had under projected the total number of households, and therefore the total population, in the Northern Bahr el Ghazal area. At the end of the original five days earmarked for household registration, the program team noticed a disproportionate number of households were not registered given the population estimates they had. With guidance from the NMCP and CCM, household registration was extended by four to five days; in this period, additional households were registered, creating the need for additional nets, which were approved for distribution.

With the strong support of key stakeholders at all levels, 983,704 nets were distributed by May 4. Despite huge challenges, the PSI team, its partners, and the government of South Sudan achieved remarkably high levels of coverage in all of the project’s target areas—and before the rainy season made distribution exponentially more difficult.

The PSI South Sudan team and stakeholders are working hard to ensure data quality checks and finalize coverage data for this campaign. Stay tuned for more final results on their achievements in the coming weeks.

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