Health

This essay looks at healthcare psychosocial support in South Sudan with specific focus on the COVID-19 crisis, postpartum and post abortion family planning, essential care of the newborn and mothers’ knowledge of mother-to-child transmission of HIV. It also looks at factors associated with neonatal sepsis in Tanzania and diabetes mellitus primary care in Uganda.

Focusing on South Sudan’s borderland with Sudan, in Northern Bahr el-Ghazal, it is clear that the national response to the virus, particularly the border shutdown, has rapidly become a new factor in Sudan and South Sudan’s cross-border political economy. The direct impact of COVID-19—like the consequences of Khartoum’s political transition and the establishment of the Transitional Government of National Unity in Juba—are yet to fully materialize in this borderland. This update summarizes the current political holding pattern around both COVID-19 and the political transitions in Khartoum and Juba, and how these interact with established long-distance trade and migrant work systems that drive the borderland economy.

This briefing is a product of the X-Border Local Research Network, a component of DFID’s Cross- Border Conflict—Evidence, Policy and Trends (XCEPT) programme, funded by UKaid from the UK government. The programme carries out research work to better understand the causes and impacts of conflict in border areas and their international dimensions. It supports more effective policymaking and development programming and builds the skills of local partners.

Is achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public’s health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015.

Methods

We conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage.

Conclusion

Health system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased.

This briefing summarizes findings from the mid-point of the Community Approaches to Epidemic Management in South Sudan research project. The project is run by the Rift Valley Institute (RVI) and funded by the UK Foreign Commonwealth and Development Office (FCDO) via the East Africa Research and Innovation Hub (EARIH). The project, which began in response to the global coronavirus pandemic, is 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. It builds on a rapid response research study conducted by RVI in April this year: Responding to COVID-19 in South Sudan: making local knowledge count.

This briefing presents time-critical findings and suggestions for action. A full report will be published at the conclusion of the project that will present geographically specific evidence including detailed community methods of infectious disease management.

Major infectious disease outbreaks in low-and middle-income countries can have serious long-lasting impacts that go beyond the direct impact of the disease, to include secondary social, economic, health and political impacts. These impacts can result from response and control measures such as quarantines, travel restrictions, and social distancing, and can be short or longer term. This rapid review synthesises evidence on the secondary impacts of response and control measures to major disease outbreaks (e.g. SARS/H1N1/MERS/Ebola etc.) in low- and middle-income countries with weak health systems or in pre-existing cries. The available evidence regarding the secondary impacts of response and control measures to major disease outbreaks in low- and middle-income countries finds that they include socio-economic impacts, secondary health impacts, and political and security impacts. A second companion paper (Kelly, 2020) looks at lessons learned from responses to these secondary impacts. These include inter-sectoral responses and co-ordination between NGOs and national governments, the importance of health systems strengthening, and cultural awareness to mitigate against stigma and the marginalisation of specific groups.