South Sudan

Project Dates: September 2012 – December 2016

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Background

The prolonged conflict in South Sudan has severely disrupted the health sector. South Sudan has a heavy disease burden with a maternal mortality ratio of 2,054 per 100,000 live births and an under-five mortality rate of 135/1,000. A 2010 assessment reported significant challenges in the pharmaceutical sector that resulted in chronic stock-outs of commodities at health facilities.

SIAPS started work in South Sudan in 2012 as a follow-on to the Strengthening Pharmaceutical Systems Program. USAID provided USD 11.2 million through SIAPS to South Sudan to support pharmaceutical system strengthening over a five-year period. SIAPS used a systems-based approach to strengthen pharmaceutical systems, build in-country capacity for commodity management, and increase the availability of essential medicines and effective pharmaceutical services.

Selected Activities

Activities aimed to strengthen pharmaceutical sector governance; enhance pharmaceutical supply management and service capacity; strengthen information systems; improve malaria planning and coordination; and strengthen malaria monitoring and evaluation systems and were implemented in partnership with the Ministry of Health (MOH) and development partners.

  • Pharmaceutical Sector Governance: To create an enabling environment to regulate pharmaceuticals and related services, SIAPS collaborated with the Directorate of Pharmaceutical Services to establish the Drug and Food Control Authority (DFCA) and pharmaceutical technical working groups (PTWGs) that would support the quantification, procurement, and distribution of health commodities.
  • Improving the Availability of Information for Decision Making: SIAPS supported the MOH and PTWGs to set up a logistics management unit (LMU) that serves as a hub for pharmaceutical supply management data. To facilitate the management of HIV/AIDS commodities, the Electronic Dispensing Tool (EDT) was installed at the Juba Teaching Hospital Antiretroviral Treatment Center. These tools and systems provide the LMU with monthly stock status reports on essential medicines.
  • Improving Storage Conditions and Availability of Essential Medicines: SIAPS worked with stakeholders to revise essential medicines kits; make them more responsive to health facility needs; and improve quantification, procurement, and distribution. To avoid further overstocks and stock-outs, a guideline for redistributing excess and near expiry essential medicines among facilities was developed. SIAPS also led the process of dejunking storage facilities that were overcrowded with expired medicines and disposing of all expired products.
  • Improving Capacity for Pharmaceutical Management and Services: In response to the immediate need for skilled technical personnel to carry out pharmaceutical management tasks, SIAPS developed a standard training curriculum. Supportive supervision visits were conducted in the Central and Western Equatoria states, and on-the-job training and support were provided to health facility staff. Through these programs, 1,210 MOH and nongovernmental organization staff were trained.
  • Scale Up of Malaria Control Interventions: To strengthen the National Malaria Control Program (NMCP) and support the scale up of malaria control interventions, SIAPS provided daily mentoring to staff at the central level. Other key interventions included malaria program reviews, sentinel surveillance of malaria commodities, and malaria indicator surveys. To mobilize additional resources, the NMCP was supported to apply for Global Fund grants under the new funding model.

Results

  • Regulatory Systems Strengthened: The DFCA controls and regulates the manufacturing, supply, marketing, distribution, and use of medicines and other products. The safety and quality of imported medicines is ensured through routine inspection and quality control testing at ports of entry. The ability to conduct these simple tests is linked to the availability of standard operating procedures, qualified personnel, and offices equipped with minilabs provided by SIAPS.
  • Improved Availability of Essential Medicines:  The PTWG enabled stakeholders to discuss parallel procurements and distributions and agree on unified mechanisms. Between 2014 and 2016, SIAPS supported the distribution of 750,000 long-lasting insecticidal nets, 635,650 doses of artemisinin-based combination therapy, 250,000 doses of sulphadoxine-pyrimethamine, and 1 million rapid diagnostic test kits.
  • Improved Availability of Data for Decision Making: Since the LMU was established, all facilities in the country use standardized reporting tools. The number of facilities reporting monthly stock status of essential medicines in supported states increased from 0% in 2013 to 94.1% in March 2016.  The success in reporting has prompted the LMU to pilot a pharmaceutical dashboard to facilitate data collection and reporting. At Juba Teaching Hospital, more than 4,000 patients have been registered in the EDT, which improves the availability of and access to accurate antiretroviral treatment data.
  • Capacity for Pharmaceutical Management and Services Improved: In addition to in-service training, supportive supervision and on-the-job mentoring helped to enhance staff’s skills in managing pharmaceuticals and services. Through training and continuous mentoring, 9 of 16 counties in the supported states can now order commodities based on consumption data.
  • Improved Storage Conditions: The dejunking of storage facilities, the provision of storage shelves, and the availability of guidelines and training on inventory management and good storage practices were key factors in improving storage conditions. By the end of 2014, facilities and county medical stores in 8 of the 10 former states of South Sudan had improved their storage conditions.
  • Malaria Program Strengthened: With SIAPS support, the malaria program was able to produce required documents that enabled it to win Global Fund grants of more than USD 97.6 million. This additional funding facilitated the scale up of malaria interventions the country.

Project Legacy

With support from USAID and SIAPS, South Sudan has made significant achievements in addressing the challenges identified in the 2010 pharmaceutical sector assessment. The country has improved its storage facilities, increased space for pharmaceuticals, and established a drug regulatory authority. The technical support provided to the MOH and partners was designed to factor in the need for continued implementation by the government ministry and partners after the close of SIAPS by working within the existing MOH structure and institutionalizing interventions through capacity building, governance, and leadership development.

South Sudan has benefited from improved information flow from facilities to the national level, which has resulted in higher visibility of data for decision making. Although a consistent reduction in stock-outs could not be documented during the course of the project, it is envisaged that with sustained emphasis on data collection and use, coordination, and human resource capacity development, South Sudan will continue to improve the availability of commodities at the facility level and reduce preventable mortality and morbidity.

The availability of human and financial resources remains a major challenge and is further complicated by the security situation in the country. The MOH will continue to require technical, leadership, and capacity support to sustain and go beyond the achievements of SIAPS.

Resources