Health

This report provides a comprehensive summary of global progress on improving water, sanitation, hygiene, waste management and environmental cleaning (WASH) in health care facilities and is intended to stimulate solution-driven country and partner actions to further address major gaps. It illustrates how stakeholders in the WASH and health sectors are increasingly working together in specific countries, with the ultimate aim of delivering safe, quality essential health services.

In the context of the current Ebola outbreak in the Democratic Republic of Congo (DRC), May 2019, this brief summarises key considerations about bushmeat (meat derived from wild animals for human consumption)in the context of preparedness activities in South Sudan. The brief details the socio-cultural and socio-economic significance of bushmeat amongst at risk communities and perceived risks of Ebola transmission through bushmeat. Its geographic focus rests on South Sudan’s south-western border with the north-eastern border of the DRC, where Yambio is the state capital and primary population hub. Key considerations and recommendations are tailored for this specific area, and may not be necessarily generalisable for other parts of South Sudan or beyond.

The brief is presented in two sections. ‘Section A’ focuses on bushmeat in light of the immediate risk of Ebola transmission from the active outbreak in the DRC to South Sudan (i.e., cross-border human-to-human transmission and in relation to the bushmeat trade). ‘Section B’ focuses more broadly on bushmeat in this specific geographic area, and the longer-term risk of a new Ebola or other infectious disease outbreak in South Sudan, as related to local bushmeat practices (i.e., unrelated to the current outbreak in DRC). The structure of this brief is designed to separate these issues and to support response partners to differentiate between the priorities for immediate preparedness activities underway in South Sudan and longer-term prevention actions.

In the oil fields of Thar Jath, South Sudan, increasing salinity of drinking water was observed together with human incompatibilities and rise in livestock mortalities. Hair analysis was used to characterize the toxic exposure of the population. Hair samples of volunteers from four communities with different distance from the center of the oil field (Koch 23 km, n = 24; Leer 50 km, n = 26; Nyal 110 km, n = 21; and Rumbek 220 km, n = 25) were analyzed for altogether 39 elements by inductively coupled plasma–mass spectrometry. Very high concentrations and a toxic health endangerment were assessed for lead and barium. The concentration of lead increased steadily with decreasing distance from the oil field from Rumbek (mean 2.8 mg/g) to Koch (mean 18.7 mg/g) and was there in the same range as in highly contaminated mining regions in Kosovo, China or Bolivia. The weighting materials in drilling muds barite (BaSO4) and galena (PbS) were considered to be the sources of drinking water pollution and high hair values. The high concentrations of lead and barium in hair demonstrate clearly the health risk caused by harmful deposition of toxic industrial waste but cannot be used for diagnosis of a chronic intoxication of the individuals.

South Sudanese people have extensive knowledge of infectious diseases and experience of organizing responses to epidemics during wars and other crises. There are multiple, locally-specific methods used by communities for interrupting infection transmission and managing epidemics. This report documents these community infectious disease management strategies, based on sustained investigative research in the Yei, Juba, Wau, Malakal, Aweil West and Rubkona areas in 2020. The research encourages collaborative engagement with local knowledge and community healthcare leadership.

This is the final report from the Rift Valley Institute’s research project, Community Approaches to Epidemic Management in South Sudan (CAEMSS). The project, which began in response to the global coronavirus pandemic, was designed to document how communities across South Sudan have created systems and structures to control the spread of epidemics and infectious diseases in the country. A summary briefing can be found here.

This report was written by Nicki Kindersley, Peter Majiek, Stephen Othur, Deng Barjok, Emmanuel Luga, Elizabeth Nyibol, Alex Miskin, Chirrilo Madut and Joseph Diing Majok.

In recent times, there has been an increasing drive to demonstrate value for money (VfM) for investments made in public health globally. However, there is limited information on practical insights and best practices that have helped implementing organisations to successfully embed VfM in practice for programming and evaluation.

In this article, the authors discuss strengths and weaknesses of approaches that been used and insights on best practices to manage for, demonstrate, and compare VfM, using a health pooled fund programme implemented in conflict-affected South Sudan as case study supported by evidence reported in the literature while critiquing adequacy of the available approaches in this setting. An expanded and iterative process framework to guide VfM embedding for health programming and evaluation is then proposed. In doing so, this article provides a very relevant one-stop source for critical insight into how to embed VfM in practice. Uptake and scale-up of the proposed framework can be essential in improving VfM and aid effectiveness which will ultimately contribute to progress towards achieving the Sustainable Development Goals by 2030.

Background: Decades of war left the Republic of South Sudan with a fragile health system that has remained deprived of resources since the country’s independence. The authors describe the coverage of interventions for women’s and children’s health in Upper Nile and Unity states, and explore factors that affected service provision during a protracted conflict.

Methods: The authors conducted a case study using a desk review of publicly available literature since 2013 and a secondary analysis of intervention coverage and conflict-related events from 2010 to 2017. During June through September 2018, they conducted 26 qualitative interviews with technical leads and 9 focus groups among health workers working in women and children’s health in Juba, Malakal, and Bentiu.

Results: Coverage for antenatal care, institutional delivery, and childhood vaccines were low prior to the escalation of conflict in 2013, and the limited data indicate that coverage remained low through 2017. Key factors that determined the delivery of services for women and children in the study sites were government leadership, coordination of development and humanitarian efforts, and human resource capacity. Participants felt that national and local health officials had a limited role in the delivery of services, and financial tracking data showed that funding stagnated or declined for humanitarian health and development programming during 2013–2014. Although health services were concentrated in camp settings, the availability of healthcare providers was negatively impacted by the protracted nature of the conflict and insecurity in the region.

Conclusions: Health care for women and children should be prioritized during acute and protracted periods of conflict by strengthening surveillance systems, coordinating short and long term activities among humanitarian and development organizations, and building the capacity of national and local government officials to ensure sustainability