Strengthening Immunization in Challenging Settings

Providing routine immunization services is a global public health priority to protect families and children from vaccine-preventable diseases such as polio, measles, and cholera. In South Sudan, the world’s newest country, the need is enormous. Without vaccination, children and their communities may be vulnerable to preventable but deadly and disabling diseases. From 2008 to 2012, South Sudan experienced its largest polio outbreak.

In any setting, the challenges to providing routine immunization services can be immense; in South Sudan, these challenges are multiplied by extensive population movement, geographically difficult-to-reach areas, developing infrastructure, and limited human resources to support the national immunization program.

It may seem simple to give a vaccine to a child, but in fact, a strong immunization program requires effective community engagement, sufficient skilled staff, as well as the ability to transport vaccines at the right temperatures, detect disease outbreaks, and track the number of children who are being vaccinated. Immunization programs are complex, requiring strong partnership and a coordinated approach. In South Sudan, the country faces a huge shortage of trained staff to support immunization.

In 2015, to respond to this challenge, the South Sudan Ministry of Health (MOH)—in partnership with the World Health Organization (WHO) South Sudan and UNICEF South Sudan, and with technical support from the Global Immunization Division at CDC—developed a way forward to train and increase the number of skilled national staff in the immunization program. The plan aimed to train 56 South Sudanese over the course of three years to strengthen the immunization program at the national and state levels. At the end of the three years, it is hoped that the successful candidates will be absorbed by the South Sudan MOH, to better protect its citizens from outbreaks associated with vaccine-preventable diseases.

To date, the program has recruited 56 mentees at the national and state levels. At the national level, mentorship is provided by the Ministry of Health, a Technical Advisor, and WHO South Sudan. Over the course of the past year, the eight mentees assigned at the national level have had solid achievements. For instance, national level mentees are gradually increasing their responsibility for immunization work that was initially supported by WHO South Sudan, a sign of increasing Ministry of Health ownership.

At the state level, the MOH State Immunization Managers, in collaboration with UNICEF, Bill and Melinda Gates Foundation (BMGF) consultants, and WHO Stop Transmission of Polio (STOP) Program volunteers, provide mentorship and on-the-job training to 48 mentees who work across the country. Having mentees at the state level has fostered more detailed planning for upcoming supplementary immunization activities.

Despite the numerous challenges that exist in South Sudan, these collaborative efforts to strengthen the immunization program have begun to show what is possible. Increasing South Sudan MOH ownership has begun to foster a sense of confidence, pride, motivation, and hope for the immunization program throughout the country.