South Sudan

Country COVID-19 Intra-Action Review (IAR) Report May 2022


Executive summary

A COVID-19 intra-action review (IAR) was conducted on 23-24 May 2022 to share lessons learned and best practices of South Sudan’s COVID-19 response between 1 June 2021 and 31 May 2022 as outlined in the second National COVID-19 Strategic Preparedness and Response Plan (SPRP). The outcomes of the IAR will be incorporated in the updated and third SPRP from 1 June 2022 to 31 May 2023.
The second year of the COVID-19 pandemic in South Sudan was negatively affected by lack of funding for most COVID-19 response interventions. Activities like sample collection, community surveillance, mortality surveillance, and contact tracing were discontinued, impacting the country’s ability to test and trace cases.
The impediment to test and trace cases hampered the ability to swiftly mobilize national and State-level Rapid Response Teams (RRT) to investigate (clusters of) COVID-19 cases.
The low number of cases and deaths reported as a result, has significantly impacted the overall population’s risk perception of COVID-19. With a very low perceived risk, people have been reluctant to wear face masks, maintain physical distancing and to get vaccinated. This is further aggravated by the lack of enforcement to adherence to these public health measures.
Furthermore, lack of contact tracing has also resulted in 74% of positive cases being lost to follow up, with the remainder of cases treated through Home Based Care. While many health facilities in the country established isolation facilities for suspected and confirmed COVID-19 cases, there was limited funding for dedicated health workers. Health partners had to prioritize their health workers for more pressing health matters.
Because of stigma, people preferred to be isolated at home, instead of in an isolation facility.
Home based care has also been hindered by lack of incentives for dedicated community health workers. Only in some locations where NGO partners decided to integrate contact tracing and home based care in community-based health programs, has the system been operationalised.
At the same time, there is no possibility to enforce suspected and confirmed COVID-19 cases to isolate in line with existing quarantine and isolation guidance.
Since the start of the pandemic, South Sudan has had just one dedicated treatment centre for severe and critical COVID-19 cases, based in the capital Juba. The Infectious Disease Unit (IDU) is fully equipped in line with WHO international standards and run by an international NGO with specialised staff who are regularly trained on the latest developments. The limited capacity within the health system to early detect COVID-19 among high risk groups, has resulted in late referrals and a relatively high mortality at the IDU. No further funding is available to maintain the IDU until end June 2022, after which it will be handed over to the MOH.

The roll out of COVID-19 vaccination was delayed by unavailability of vaccines and insufficient funding until the late 2021-early 2022. Difficult access to large parts of the country, due to lack of infrastructure, insecurity, and flooding has slowed down the implementation of regular and intensified COVID-19 vaccination activities.
In spite of these challenges, South Sudan managed to vaccinate 7% of its population by 23 May 2022. Thanks to these efforts by implementing partners with support from the United Nations Humanitarian Air Service (UNHAS) for transport of vaccines, the country managed to mobilize sufficient vaccines as well as funding earmarked for operational expenses for COVID19 vaccination.
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. Still many health facilities report stock out of PPE, mostly due to lack of knowledge how to replenish supplies, or low risk perception.
There has also been a sufficient supply of laboratory reagents for RT-PCR testing, however testing was challenged by lack of incentives for health workers to collect samples, as well as the actual testing itself. Many laboratory staff were therefore recruited by private laboratories, seriously affecting the functioning of the National Public Health Laboratory (NPHL) in Juba, as well as the Molecular Laboratory established for this specific purpose at the Wau Teaching Hospital.
The roll out of antigen rapid diagnostics tests (Ag RDT) for COVID-19 throughout South Sudan was slow, causing several Ag RDTs to expire before being used. While many NGO partners are currently using Ag 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 Ag RDT positivity rate during the first 5 months of 2022 confirms COVID-19 is still circulating in South Sudan.
Where testing is done, cases are found.
South Sudan has received 39M USD from the Global Fund COVID-19 Response Mechanism (C19-RM) through UNDP and various sub-recipients for surveillance, laboratory, and case management until end 2023. Most of the funding is for construction, procurement of supplies, and training activities, while only a small amount can be used for incentives for health staff.
South Sudan has also received approximately 48.3M USD from different donors for COVID19 vaccination, the majority of which (29M USD) from the World Bank through UNICEF until end 2023. An additional 35M USD is allocated by the World Bank for the procurement of vaccines.
While the country’s COVID-19 response seems well-funded, many core interventions cannot be implemented as the available funding does not allow for payment of incentives of health workers, unless it is for COVID-19 vaccination. As long as the government is unable 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 staff.
Unfortunately, dedicated COVID-19 incentives have led to a much lower coverage for childhood immunization, as vaccinators prefer to be engaged in COVID-19 vaccination, neglecting other Vaccine Preventable Diseases.
The integration of COVID-19 response interventions into routine health programs aims to address many of the above challenges.
With below 10% of the population fully vaccinated against COVID-19, porous borders and limited control measures, South Sudan remains at elevated risk of further surges in COVID-19 cases, especially in view of the potential emergence of new variants.