Juba 11 December 2017: In South Sudan, cholera continues to hit communities already made vulnerable by disasters such as conflict and hunger catastrophe.

In 2017, South Sudan braced the most protracted and biggest cholera outbreak. The outbreak was first detected in July 2016 and since then over 21 000 cholera cases and 462 deaths (CFR 2.14%) have been reported from 27 Counties countrywide.

To avert the speed at which cholera was spreading among the population who have suffered from the consequences of conflict and worst food crisis, WHO’s famine incident management team and the national cholera taskforce have managed to contain the cholera outbreak with sporadic transmission reported in two counties, Juba and Budi.

To further reinforce these gains, WHO in collaboration with partners supported the Ministry of Health to enhance capacities for emergency and outbreak preparedness and response through a series of activities undertaken from 27 November to 7 December 2017. The activities included: a refresher training for a multi-sectoral rapid response team followed by a review of the national program for integrated disease surveillance and response (IDSR) and an after-action review (AAR) of the cholera response.

Honorable Dr Riek Gai Kok, Minister of Health, expressed gratitude to donors, WHO and partners for their commitment to supporting the efforts of the Government of South Sudan to improve health services. He also urged the rapid response team to cascade the knowledge and skills to the lower levels. 

Addressing the needs of the affected population in remote areas

Across the country, an integrated rapid response mechanism is in place to reach desperate people in remote areas of South Sudan where vulnerable populations like children and pregnant women are at risk of death from preventable and malnutrition-related causes has increased dramatically and a hunger catastrophe is looming.

In light of increasing risks of emerging and re-emerging disease outbreaks and epidemics, the Ministry of Health with support from WHO trained 45 multidisciplinary experts drawn from the national Ministry of Health, Ministry of Humanitarian and Disaster Management, Ministry of Water Resources and Irrigation, Ministry of Petroleum, and Juba City Council to enhance the capacity to effectively respond to cholera and other public health hazards. 

“Integrating the overall International Health Regulations (2005) core capacities and building the capacity of rapid response teams are vital to provide life-saving health services and respond to public health threats,” said Mr Evans Liyosi, WHO Representative a.i. to South Sudan. The rapid response teams are providing timely and appropriate treatment to people who have had little or no access to health care services. 

To offer experiences throughout the training process, simulation of outbreak scenarios were integrated into the training to provide the rapid response teams with opportunities for functional capacities of outbreak investigation and response as well as cascading the training to the lower levels to ensure corresponding capacities at the sub-national level.
 

Improving reporting performance and capacity to detect outbreaks

Whenever a disaster or emergency impacting health occurs, the period of time between the crisis and the response is critical in saving lives.

To contain disease outbreaks more quickly, rapidly and effectively through efficient surveillance and laboratory work, effective coordination, and a strong workforce, the Ministry of Health, along with WHO, the state Ministry of Health directors general and state surveillance officers and partners, reviewed the IDSR progress and achievements in 2017, with the aim of improving the performance of surveillance in 2018.

The IDSR system in South Sudan has been instrumental in identifying and responding to disease outbreaks. In 2017, the IDSR system helped in identifying, investigating and responding to 839 alerts of suspect cholera, measles, bloody diarrhoea, Guinea worm, and malaria from multiple locations.  However, more effort is required to attain the national target of at least 80% or above reporting rate.

"Our target is to have more than 80% timely reporting," said Dr Matthew Tut, the Director of Emergency Preparedness and Response (EP&R) Department in the Ministry of Health. To enhance capacities for disease surveillance and response, Dr Tut pleaded states and counties to work towards attaining the optimal surveillance performance level of more than 80%.

“Rapid case detection and response are key to save lives and protect people from health threats,” said Dr Wamala Joseph, Epidemiologist at WHO South Sudan.  The effectiveness of emergency response interventions is a function of advance planning and initiation of preparedness activities including strengthening the implementation of IDSR strategy, Dr Wamala added.

At the end of the review, a new plan for improving surveillance performance in both stable and conflict-affected areas was endorsed by the Minister of Health. To achieve this, the Ministry of Health is committed to double efforts towards enhancing capacities for disease surveillance and response through the rollout of mobile reporting and community-based disease and event surveillance to the health facility and community levels. 

Preventing cholera recurrence

To reverse the current cholera trend in South Sudan, the AAR of the cholera response endorsed the global roadmap of attaining a 90% reduction of cholera deaths by 2030. Consequently, the National cholera response strategy has been updated to achieve these ambitious targets.

The strategy entails three core axes of implementation: enhanced coordination and leadership through the establishment of a multisectoral National Control Program that reports to the office of the President; enhancing capacities for early detection and rapid initiation of a multi-sectoral, multi-disciplinary response to rapidly contain and prevent widespread outbreaks as well as implementing long-term and sustainable interventions to prevent the recurrence of cholera outbreaks in cholera transmission hotspots.

Since the onset of the 2013 crisis, cholera outbreaks have been confirmed every year and have increasingly become bigger and more protracted, says Dr Wamala.  As a result, the number of cases and deaths have increased every year affecting the vulnerable populations living in urban slums, rural populations, cattle camp and island dwellers, and communities along the River Nile. Sustainable collaboration and commitment are required to ensure effective support for surveillance, outbreak investigation, and disease prevention and control.

“We appreciate the support from our partners especially the United States Agency for International Development (USAID), the European Civil Protection and Humanitarian Aid Operations (ECHO) and the Government of Japan that provide funding support in those areas,” says Mr Liyosi.

WHO is committed to support the Ministry of Health to enhance the effectiveness of the national surveillance system guided by the IDSR strategy and the International Health Regulations (2005). WHO is also committed to providing the required technical support to develop a costed national cholera prevention and control plan for eliminating cholera deaths by 2030.