Prior to South Sudan’s independence, a civil war between 1983 to 2005 displaced more than 4 million people. As a result of renewed conflict in July 2016, it is estimated that more than 2 million South Sudanese are refugees. Roughly half of the country’s population is on the move and live in extreme poverty. About 90% percent of the people live on less than $1 a day, and less than 30% of the children are enrolled in primary school, of which only 19% complete.
South Sudan has very high infant mortality rate at 102 per 1,000 live births, and under-five mortality rate at 135 per 1,000 live births. Further, South Sudan has one of the highest maternal mortality rates in the world, estimated at 2,054 per 100,000 live births.
PSI began operations in Southern Sudan in January 2005, distributing Serena brand long-lasting insecticide-treated nets through the commercial sector and implementing behavior change communication on HIV/AIDS.
Over the years, PSI operations included:
- Implementation of comprehensive hygiene, sanitation and safe water program in the cities of Juba, Yei and Wau.
- Comprehensive HIV programming that includes community outreach and capacity building of community based organizations.
- Distribution of branded and non-branded condoms.
- Outreach and support to people living with HIV/AIDS to mitigate the impact of opportunistic infections.
- Support to County AIDS Commissions, the Ministry of Health and South Sudan AIDS Commission.
In 2009, PSI started a Home Management of Malaria (HMM) program for children under five years old. Since then, HMM has evolved into a broader integrated community case management (ICCM) program with the addition of pneumonia, diarrhea and severe acute malnutrition treatments. For the iCCM program, PSI/South Sudan operates in conjunction with the Ministry of Health at both the national and county levels along with NGO and humanitarian partners.
Currently, PSI provides support to the Ministry of Health and National Malaria Control Program (NCMP) to prevent and to treat malaria, in addition to the iCCM Program.
PSI/South Sudan currently distributes:
- Long lasting insecticide treated nets (LLINs) for prevention of malaria.
- Sulfadoxine Pyrimethamine for prevention of malaria in pregnant women.
- Rapid diagnostic test (RDTs) for malaria testing.
- Artemisinin-based combination therapy (ACT) for uncomplicated malaria treatment.
- Artesunate injectable for severe malaria treatment.
- Amoxicillin for pneumonia treatment.
- ORS+Zinc for treatment of diarrhea.
- Plumpy’Nut at outpatient therapeutic program sites supplied by United Nations Children’s Fund (UNICEF).
PSI/South Sudan estimates that in 2015, its products and services helped avert 1,059,756 DALYs, including, by health area:
- 558,117 Malaria DALYs
- 500,838 MNCH DALYs
- 801 WASH DALYs
Child Health
PSI/South Sudan’s child survival efforts are focused on finding the most appropriate approach to providing hard to reach communities them with quality and effective, integrated health services that address the main causes of childhood morbidity and mortality.
Integrated Community Case Management (iCCM)
iCCM provides an umbrella service covering diagnosis and treatment of malaria with Artemisinin-based combination therapies (ACTs) and gradual introduction of rapid diagnostic tests (RDTs); pneumonia with Amoxicillin; and diarrhea with ORS+Zinc for children under five years old. These services are provided, using community-based distributors (CBDs) who volunteer their time to serve the community they reside in. CBDs are also known in South Sudan as ‘front line workers’. Community nutrition workers and volunteers (CNW/V) handle severe acute malnutrition cases in the outpatient therapeutic program (OTP) sites. CBDs are trained to diagnose acute malnutrition cases.
These trained CBDs and CNVs serve as a first point of contact for remote populations, increasing access to quality health services, products and key messages dramatically. In South Sudan, CBDs are supplied with appropriate first line medicines which are distributed free to the beneficiaries.
The program currently operates in Wau, Jur River, Yei, Morobo Lainya, West Mundri and Mundri East counties of Western Bahr el Ghazal, Central Equatoria and Western Equatoria states. PSI/South Sudan partners with other NGOs to extend the program to other parts of the country.
Behavior Change Communication
PSI/South Sudan relies on behavior change communications techniques to:
- Raise community awareness of malaria, pneumonia, diarrhea and malnutrition.
- Promote prevention and encourage early treatment through community meetings.
Malaria and Child Survival
In order to prevent malaria infections, PSI/South Sudan, with its partners, distributed millions of long-lasting insecticide treated nets (LLINs). The program takes a two-pronged approach: 1) periodic mass distribution efforts to ensure that households have a new net every three years; and 2) routine distribution of nets via clinics for pregnant mothers and women with children under five years old.
- Over 2.5 million LLINs provided through mass distribution throughout September 2016.
- Over 424,000 LLINs provided through routine distribution throughout September 2016 at health facilities.
- 3,681,275 ACTs procured from 2015 to 2016.
- 523,035 Artesunate injectable procured.
- 120,000 Sulfadoxine Pyrimethamine procured.
- 2,235,947 RDTs procured.
- Over 2.5 million malaria cases treated throughout September 2016 and over 770, 000 cases treated in 2015.
- Over 894,000 pneumonia cases treated throughout September 2016 and over 332,085 cases treated in 2015.
- Over 1,037,000 diarrhea cases treated throughout September 2016 and over 337,000 cases treated in 2015.
- Over 153,000 sever acute malnutrition cases treated throughout September 2016 and over 1.1 million children under five screened for acute malnutrition by the end of September 2016.
Donors
- UK Department for International Development (DfID)
- The Global Fund to Fight AIDS, Tuberculosis and Malaria
Partners
- Ministry of Health, Government of South Sudan, National Malaria Control Program
- World Health Organization (WHO)
- United Nations Children’s Fund (UNICEF)
- United Nations Development Programme (UNDP)
- Save the Children
- Malaria Consortium
- International Rescue Committee
- Bangladesh Rural Advancement Committee
- IMA World Health
- Action Against Hunger International (AAHI)
- Johanniter International Assistance
- Mercy Corps
- Action Africa Help
- Catholic Medical Mission Board (CMMB)
- Collegio Universitario Aspiranti Medici Missionari (CUAM)
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries. - Follow the Need: Recipe for Scaling Up Access to Quality Pneumonia, Diarrhea and Malaria Case Management in South Sudan
Looking at certain 'ingredients,' this case study outlines how PSI and partners are working to scale up access to, quality of, and demand for improved health services and products in South Sudan using integrated community case management (iCCM). It also delineates keys to success and lessons learned from the study. - 8 iCCM Programs Highlight Diverse Approaches to Reduce Top Child Killers
This brief shows how PSI is exploring models to scale-up integrated community case management (iCCM) of pneumonia, diarrhea and malaria for remote populations. - PSI’s Sanitation Program in South Sudan
Overview of PSI's community-led total sanitation program in South Sudan. - Follow the Need: Recipe for Scaling Up Access to Quality Pneumonia, Diarrhea and Malaria Case Management in South Sudan
South Sudan has one of the highest childhood mortality rates in the world. This case study highlights and outlines the need for scaling up access to quality pneumonia, diarrhea, and malaria case management. - 2012 Mid Year Region and Country Dashboards, East Africa
Mid-year East Africa region and country impact dashboards for 2012 - 2011 Region and Country Dashboards, Eastern Africa
Eastern Africa region and country impact dashboards for 2011