South Sudan

Dracunculiasis is infection with Dracunculus medinensis, a nematode worm, also known as Guinea worm. It is caused by drinking water containing water fleas (Cyclops species) that have ingested Dracunculus larvae.

Since 2006, the guinea worm programme has been establishing a community-based surveillance system capable of detecting index Guinea worm cases in endemic and at-risk villages of South Sudan and an effective intervention delivery system to break racunculiasis transmission.

Surveillance and intervention delivery activities continue to be strengthened in South Sudan’s known endemic and at-risk villages. In Guinea worm-free areas, WHO is supporting the merger of passive surveillance activities into the emerging Integrated Disease Surveillance and Response system. There are 5884 villages under active surveillance in South Sudan (2011).

During 2011, the programme reported a total of 1028 guinea worm cases from 304 endemic villages compared to 1698 cases in 2010. This figure represented a 39% reduction and 78% of the reported cases in 2011 were contained.

Of cases reported in 2011, 75% were reported from Eastern Equatoria State, 11% from Warrap State and 6% from Jonglei State, with the rest reported from Central Equatoria, Lakes and Western Bhar El Gazel states.

WHO includes mental well-being in its definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

Evidence is emerging that positive mental health is associated with good physical health, meaningful long-term relationships, a sense of belonging, good education and being employed in a healthy working environment.

On the other hand, social disadvantages increase the risk of mental, neurological and substance use  disorders in all societies, irrespective of the wealth of the country.

Given that South Sudan has just emerged from a long civil war, it is likely that many of its people have under through post-traumatic stress disorder.

To address the problems related to mental health, WHO has supported the Ministry of Health to develop a mental health strategy. This will be used to improve mental health services in the country.

The programme in South Sudan is:

• leading the health cluster
• building the capacity of the Ministry of Health in disaster risk reduction
• assisting in prepositioning of life-saving supplies
• supporting advocacy and resource mobilization in collaboration with Ministry of Health and partners
• strengthening secondary health care.

South Sudan experiences a wide variety of environmental problems, including soil degradation due to the widespread deforestation with consequent loss of biodiversity and wildlife habitats, pollution of rivers and the environmental due to oil drilling in the wetlands, over-exploitation of fisheries and conflicts over diminishing resources such as rangelands and water sources for livestock.

Environmental factors impact on health. There has been an increase in environment-related diseases such as malaria, typhoid and watery diarrhoeal diseases. This situation is largely due to widespread water contamination by urban surface runoff and poor environmental sanitation. This is the result of inadequate disposal of both solid and liquid wastes on open ground.

WHO is supporting the Ministry of Health to develop an environmental health policy for South Sudan. The draft is currently in consultation and will be widely disseminated and implemented once finalized.

The programme focuses on improving access to primary health care and on environmental health, particularly the provision of clean drinking-water, vector control, solid waste removal, excreta disposal and promotion of a healthy environment in internally-displaced persons/refugee camps.

This area of work also includes nutrition, reproductive health, gender-based violence and mental health advocacy.

WHO supports the Ministry of Health in all the components of health system strengthening including:

• human resources development through training within and outside South Sudan
• capacity-building of the pharmaceutical department
• policy formulation, planning and management
• biomedical information
• emergency humanitarian action
• laboratory systems strengthening.

The Organization also contributes to rehabilitation, maintenance and capacity-building in local hospitals and laboratories.

The programme provides strategic leadership for the national health sector response to HIV/AIDS. WHO provides technical support to the national HIV/AIDS programme to scale-up treatment, care and prevention services, as well as maintain and increase access to drugs and diagnostics, and acquisition of strategic information.

By the end of 2011, WHO, with support from Global Fund to Fights AIDS, Tuberculosis and Malaria,had assisted the development of normative and technical guidance to support:

• the scale-up of HIV/AIDS interventions in the health sector
• monitoring and evaluation
• HIV/sexually transmitted infection (STI) surveillance
• blood safety
• strategic and operational planning for HIV/AIDS and STIs
• capacity-building including provision of mentorship and training for health-care providers.

As of December 2011, 22 health facilities were offering antiretroviral therapy, with around 8900 patients accessing HIV care services, of which 3442 are reported to be on antiretroviral treatment.

Over 50 000 people have accessed voluntary HIV testing and counselling services and over 40 000 pregnant women have received services for prevention of mother-to-child transmission of HIV over the last year.

Under this programme area, WHO provides:

• policy and technical support
• equips the health system to detect, assess, respond and cope with epidemics and pandemic-prone diseases
• develops, strengthens and maintains the capacity of the Ministry of Health to detect, report and respond to disease

WHO also supports the Ministry of Health to:

• ensure greater impact of immunization services
• supports the Ministry of Health to maintain HIV prevalence at less than 2%
• supports the Ministry of Health to provide effective coordination and prevent, control, eliminate and eradicate neglected tropical diseases.

This is currently the biggest programme of WHO in South Sudan. The programme supports vigorous outbreak responses through national immunization campaigns.

WHO will continue supporting the Ministry of Health to maintain the polio-free status of all ten States of South Sudan, while improving the coverage of measles immunization among children to contain the current outbreak.

WHO estimates the incidence of tuberculosis (TB) in South Sudan to be at 79 per 100 000 for new sputum smear positive TB and 140 per 100 000 for all forms of TB cases.

The national tuberculosis, leprosy and Buruli ulcer control programme, in collaboration with its partners, coordinates, monitors and supervises the implementation of TB-related activities.

WHO plays a significant role in strengthening the capacity of the national programme by providing financial and technical support for:

• delivery of diagnostic and therapeutic TB services
• conducting assessments
• collection of sputum specimens
• distribution of information, education and communication materials
• supervisory support and mentoring visits
• capacity-building workshops

South Sudan experiences a wide variety of environmental problems, including soil degradation due to the widespread deforestation with consequent loss of biodiversity and wildlife habitats, pollution of rivers and the environmental due to oil drilling in the wetlands, over-exploitation of fisheries and conflicts over diminishing resources such as rangelands and water sources for livestock.

Environmental factors impact on health. There has been an increase in environment-related diseases such as malaria, typhoid and watery diarrhoeal diseases. This situation is largely due to widespread water contamination by urban surface runoff and poor environmental sanitation. This is the result of inadequate disposal of both solid and liquid wastes on open ground.

WHO is supporting the Ministry of Health to develop an environmental health policy for South Sudan. The draft is currently in consultation and will be widely disseminated and implemented once finalized.

In South Sudan, WHO supports:

• strengthening the delivery of the basic package of health services
• community-based initiatives
• expansion of the Integrated Management of Childhood Illness
• improvement of maternal and child health
• prevention of blindness and eye care. 

South Sudan has the highest maternal mortality rate in the world at more than 2054 out of every 100 000 live births. This is mainly due to inadequate access to primary and curative health services and a low demand for, and awareness of, preventive services.

Despite efforts to train midwives, skilled attendance at births has remained very low compared to the neighbouring countries. Under-5 mortality is 135 out of every 1000 live births.

WHO is supporting the Government to cut the mortality rate. With support from the Canadian International Development Agency (CIDA), WHO is constructing maternity units in eight State hospitals. The pilot maternity unit was constructed in Bor State hospital. This project will run for a period of five years.