COVID-19 Intra-Action Review (IAR) Report by Country May 2022 – South Sudan

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Summary

A COVID-19 Intra-Action Review (RIA) was conducted on May 23-24, 2022 to share lessons learned and best practices from South Sudan’s COVID-19 response between June 1, 2021 and May 31, 2022, as reported in the second national COVID-19 report. Strategic Preparedness and Response Plan (SPRP). The results of the ARI will be incorporated into the update and the third SPRP from June 1, 2022 to May 31, 2023.
The second year of the COVID-19 pandemic in South Sudan has been negatively affected by the lack of funding for most COVID-19 response interventions. Activities such as sample collection, community surveillance, mortality monitoring and contact tracing have been halted, impacting the country’s ability to test and find cases.
The hurdle in testing and tracking cases has hampered the ability to quickly mobilize national and state-level Rapid Response Teams (RRTs) to investigate (clusters of) COVID-19 cases.
The low number of reported cases and deaths as a result has had a significant impact on the perception of the risk of COVID-19 by the general population. With a very low perceived risk, people have been reluctant to wear face masks, maintain physical distancing and get vaccinated. This situation is further aggravated by the lack of enforcement of these public health measures.
In addition, the lack of contact tracing also resulted in 74% of positive cases being lost to follow-up, with the rest of the cases treated through home care. While many health facilities across the country have set up isolation facilities for suspected and confirmed cases of COVID-19, funding for dedicated health workers has been limited. Health partners had to prioritize their health workers for the most pressing health issues.
Due to stigma, people preferred to be isolated at home rather than in an isolation centre.
Home-based care has also been hampered by the lack of incentives for dedicated community health workers. Only in some places where NGO partners have decided to integrate contact tracing and home-based care into community health programs has the system been operationalized.
At the same time, it is not possible to impose isolation of suspected and confirmed cases of COVID-19 in accordance with existing quarantine and isolation guidelines.
Since the start of the pandemic, South Sudan has had only one dedicated treatment center for severe and critical cases of COVID-19, based in the capital Juba. The Infectious Diseases Unit (IDU) is fully equipped according to WHO international standards and managed by an international NGO with specialist staff who are regularly trained in the latest developments. The limited ability of the health system to detect COVID-19 early among high-risk groups has resulted in late referrals and relatively high mortality in IDU. No other funding is available to maintain the IDU until the end of June 2022, after which it will be handed over to the Ministry of Health.

Roll-out of COVID-19 vaccination has been delayed by unavailability of vaccines and insufficient funding until late 2021-early 2022. Difficult access to large parts of the country, due to lack of infrastructure, insecurity and flooding has slowed the implementation of regular and intensified COVID-19 vaccination activities.
Despite these challenges, South Sudan has managed to vaccinate 7% of its population as of May 23, 2022. Thanks to these efforts by implementing partners with the support of the United Nations Humanitarian Air Service (UNHAS) for the transport of vaccines , the country has managed to mobilize enough vaccines as well as funds for operational expenditures for vaccination against COVID19.
Similarly, coordinated by the Logistics Cluster, South Sudan benefited from sufficient supplies of PPE (face masks, coveralls and hand sanitizers) and an efficient system to distribute and deliver these supplies to NGO partners. Many healthcare facilities are still reporting stock-outs of PPE, mostly due to a lack of knowledge on how to replenish stock or a low perception of risk.
There has also been an adequate supply of laboratory reagents for RT-PCR testing, but testing has been challenged by the lack of incentives for health workers to collect samples, as well as the test itself. same. Many laboratory personnel have therefore been recruited by private laboratories, seriously affecting the functioning of the National Public Health Laboratory (NPHL) in Juba, as well as the Molecular Laboratory created for this specific purpose at the University Hospital of Wau.
The roll-out of rapid antigen diagnostic tests (Ag RDTs) for COVID-19 across South Sudan has been slow, resulting in several Ag RDTs expiring before they can be used. While many NGO partners currently use agricultural RDTs, reporting remains a challenge, with many partners not bothering to send reports back to the NPHL if all results are negative. An increase in the Ag RDT positivity rate in the first 5 months of 2022 confirms that COVID-19 is still circulating in South Sudan.
Where testing is done, cases are found.
South Sudan has received $39 million from the Global Fund’s COVID-19 Response Mechanism (C19-RM) through UNDP and various sub-recipients for surveillance, laboratory and case management so far. by the end of 2023. Most of the funding is for construction, purchase of supplies and training activities, while only a small amount can be used for incentives for health workers.
South Sudan has also received around $48.3 million from different donors for the COVID19 vaccination, the majority ($29 million) from the World Bank through UNICEF until the end of 2023. 35 million additional dollars are allocated by the World Bank for the purchase of vaccines.
While the country’s response to COVID-19 appears to be well-funded, many basic interventions cannot be implemented as available funding does not allow for payment of incentives to health workers except for vaccination against COVID-19. 19. Until the government is able to pay adequate salaries to its health workers, the country’s response to COVID-19 will remain dependent on donor funding through the payment of incentives to health workers.
Unfortunately, dedicated COVID-19 incentives have led to much lower coverage for childhood vaccinations, as vaccinators prefer to be engaged in COVID-19 vaccination, neglecting other vaccine-preventable diseases.
Integrating COVID-19 response interventions into routine health programs aims to address many of the above challenges.
With less than 10% of the population fully vaccinated against COVID-19, porous borders and limited control measures, South Sudan remains at high risk of further outbreaks of COVID-19 cases, especially given the potential emergence of new variants.

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