1. Challenges and opportunities of control and elimination of NTDs in Southern Sudan
APPMG
December 17, 2008
Presented by Dr. John P. Rumunu (MPH, MB.BS)
Director General, Preventive Medicine
MoH-GoSS

2. The Operational Context
Large area (640,000 sq. km) and dispersed population (10 m)
Prolonged rainy seasons and flooding
Post conflict situation
Comprehensive Peace Agreement (Jan 9, 2005)
Disruption of health infrastructure, health human resources and health care delivery system
Population movement- impacting on disease distribution including NTDs

3. Burden of Neglected Tropical Diseases
Parasite
Disease (Common Name)
Burden
Protozoan
Human African Trypanosomiasis
1 – 2 million people at risk
Leishmaniasis
Cyclic ( cases/year), up to 100,000 during epidemics
Bacterial
Buruli ulcer
1000 (+) cases
Leprosy
Trachoma
3.9 million at risk in surveyed areas
Helminth
(Worms)
Onchocerciasis
(River Blindness)
4.1 million at risk, of which 3.6 million eligible for treatment
Lymphatic filariasis
(Elephantiasis)
All areas surveyed to date found to be endemic
Soil-transmitted helminths
Schistosomiasis
(Bilharziasis)
Loiasis
Dracunculiasis
(Guinea Worm)
Approx 20,000 cases in 2006
Unknown
Nodding Syndrome
The multiple burden of different Neglected Tropical Diseases (NTDs) in Southern Sudan is among the greatest in Africa
A total of 12 NTDs are endemic (see next Slide)
Many only benefit from intermittent control in response to reported outbreaks, supported by short-term donor funding.
The need to implement and scale-up appropriate, cost-effective interventions is nowhere as apparent as in this post-conflict setting

4. Enabling environment Southern Sudan Interim Health Policy
Mission: Commitment to ensure equitable sector-wide, accelerated and expanded quality health care for all people in Southern Sudan, especially women and children
Goal: The goal of the Interim Health Policy ( ) is to improve the health of the people of Southern Sudan through strengthening the health system at all levels and in particular increasing and strengthening the coverage of the primary health care system and services, including the referral system

5. Enabling environment Objectives
Improving the delivery of accessible, acceptable, affordable, sustainable, cost effective maternal and child health interventions and nutrition programmes
Enhancing and accelerating disease prevention and control programmes
Strengthening the health system at all levels
Develop a comprehensive approach to resource development including planning, training, and continuous education of management personnel
Institutionalize effective partnerships with other stakeholders through coordination and other collaborative mechanisms

6. Current Status of Interventions
Within its policy framework the Government of Southern Sudan (GoSS) immediately recognized NTDs as a major obstacles to be overcome to improve the health of its people
The Ministry of Health (MoH) has prioritized the control or elimination of some diseases e.g.
Onchocerciasis,
Guinea worm and
Trachoma
Expanding resources to lead the control of human African Trypanosomiasis (HAT) and Visceral Leishmaniasis.

7. Current Status of Interventions
Now MOH moving toward the integrated control of NTDs using preventive chemotherapy (PCT) and complementary approaches, as recommended by the World Health Organization.
This approach targets:
Soil-transmitted helminths (causing ascariasis, trichuriasis and hookworm disease),
Schistosomiasis,
Lymphatic filariasis (LF),
Trachoma and
Onchocerciasis
Through Mass Drug Administration (MDA) strategy.
A National Integrated NTD Control Programme Technical Committee was established in April 2008 to coordinate this new approach.

8. National Integrated NTD Control Programme Technical Committee

9. Coordination of integrated NTD control from central to peripheral level

10. Opportunities Reconstruction Partnership
Enabling environment
Emerging Health System
Partnership
Involvement of national and international stakeholders
Funding from DFID (seed money) through COMDIS to conduct a national NTD situation analysis
Funding through RTI from USAID
Mapping and
Subsequent MDA in limited areas
Development of evidence-based innovative delivery system for NTDs Control/elimination
Opportunity for scaling up intervention to all endemic areas per the mapping result

11. Conclusion There is high burden of NTDs in Southern Sudan
There is political will and commitment as evidenced by policies, strategic plan and structures for NTDs control and elimination
Current funding secured is only enough for mapping and small scale PCT through MDA in limited areas
Need for more funding to scale up PCT in all endemic areas