Routine immunisation Conflict & humanitarian Gender equality

Improving immunisation rates in South Sudan’s most remote region

Some communities in Pibor haven’t received vaccines since the country’s independence 11 years ago. Health workers are now working to turn the situation around.

13 July 2022
5 min read
by Winnie Cirino
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<article> <h1> <span>Improving immunisation rates in South Sudan’s most remote region</span> </h1> <div><p>Some communities in Pibor haven’t received vaccines since the country’s independence 11 years ago. Health workers are now working to turn the situation around.</p> </div> <ul> <li> <b>13 July 2022</b> </li> <li> <b class="me-2">by</b> <span> <a href="https://www.gavi.org/vaccineswork/authors/winnie-cirino" hreflang="en">Winnie Cirino</a> </span> </li> </ul> <div> <div> <div> <div> <div> <p> </p> <p>Pibor Administrative Area has some of the lowest immunisation rates in South Sudan. Santino Kiron Thewa, the local Community Health Director, says there are communities in the region that have not received vaccines since South Sudan got its independence 11 years ago. </p> <p>“One of our challenges is the conflict that has destroyed several of our facilities, including cold chain, in different community areas,” Thewa says, adding that road accessibility is another concern.</p> <blockquote> <h2>“If there is fighting going on, you get scared. If I go [to an immunisation session], and the fighting reaches my home, who will look after the rest of my children when people flee the area?”</h2> </blockquote> <p>“In Labarak, there has been no vaccination of people as there is no cold chain and the health facility is not well functioning. This is due to the lack of roads. The only real access for health workers is to cross Jebel Boma’s Boma mountain, which is a risky endeavour.</p> <p>Thewa suggests an alternative, saying, “If we have a chopper [helicopter] to transport health workers there, it will be good. We can even leave health workers there for up to seven days to provide health services and immunisation.”</p> <p></p> <p>In counties like Legwangule and Gumuruk, some payams (administrative divisions) are far and don’t have health centres for people to access the vaccines. Mothers have to walk for one to two hours to reach the health centre and then make the return trip. It becomes riskier when conflicts break out.</p> <p>“If there is fighting going on, you get scared. If I go, and the fighting reaches my home, who will look after the rest of my children when people flee the area?” asks Rebecca Juajing, a mother of six children living in Pibor. </p> <p>“That’s one of the reasons why we [mothers] don’t take our children for immunisation on the days that we are meant to go. When there’s conflict, we often stay indoors for days on end. Another concern is that I am afraid of being attacked with my child while on the way to the hospital,” Juajing adds.</p> <blockquote> <h2>“The mothers in cattle camps don’t bring their children for vaccination. There is a need to reach out to them but, with the poor road network, general accessibility and insecurity, one needs to establish centres to protect both the medicines and the health worker.”</h2> </blockquote> <p>Twenty-nine-year-old Mali Korok, who also hails from Pibor Administrative Area, says that the existing hospital in Pibor almost has no purpose because it lacks the necessary equipment and medicines for it to function as a hospital.</p> <p>“The hospital here is not like a regular hospital because it cannot treat most illnesses. There are many children suffering and dying from different diseases like tuberculosis but the hospital cannot treat them. Pregnant women also suffer a lot and sometimes die due to a lack of blood supplies,” Korok says.</p> <div> <h4>Have you read?</h4> <ul> <li><a href="https://www.gavi.org/vaccineswork/reaching-zero-dose-children-northern-kenya" title="Reaching zero-dose children in northern Kenya">Reaching zero-dose children in northern Kenya</a></li> <li><a href="https://www.gavi.org/vaccineswork/reaching-communities-immunisation-south-sudan" title="Reaching communities with immunisation in South Sudan">Reaching communities with immunisation in South Sudan</a></li> <li><a href="https://www.gavi.org/vaccineswork/south-sudan-we-are-ready-take-challenge" title="South Sudan: We are ready to take up the challenge">South Sudan: We are ready to take up the challenge</a></li> </ul> </div> <p>Clean water for domestic use is another concern, Korok says: “There are very few water sources in residential areas. There is only one borehole in my area and everyone fetches water from it, which results in fights. Some people resign themselves to getting water from the stream, which is very dirty, undrinkable and makes one sick. We really need more boreholes, but also for the issue of the hospital to be addressed.”</p> <p>James Chacha Konyi is the County Health Coordinator for the national non-governmental organisation, LiveWell, that is implementing an immunisation programme in Pibor. He says that while turnout for routine immunisation in towns has been good, it is poor in the rural areas. </p> <p>“The mothers in cattle camps don’t bring their children for vaccination. There is a need to reach out to them but, with the poor road network, general accessibility and insecurity, one needs to establish centres to protect both the medicines and the health worker,” Konyi says. </p> <p>He acknowledges that health workers are not operating in some payams due to the lack of facilities.</p> <blockquote> <h2>“We are using new technology that can store vaccines for a longer period without electricity or power. We are also working with partners to access vaccines and make sure they get into areas before the rainy season.”</h2> </blockquote> <p></p> <p>“There are no resources like solar fridges in those areas to store and maintain vaccines. With limited funding, it is difficult to cover those areas, which results in counties like Nanaam county being completely cut off,” Konyi explains.</p> <p>He adds that to encourage mothers to complete their children’s immunisation, Livewell does provide incentives. “We have some activities that encourage them [mothers] to come to the facility to complete immunisation, especially for the last dose of Penta 3. At the end, we give mothers things like mosquito nets and we find that it does help,” Konyi says. </p> <p>While immunisation rates in Pibor have been poor, Nay Myo Thu, Cold Chain Specialist at the United Nations Children Emergency Fund (UNICEF) in South Sudan feels some progress has been made this year. </p> <p>“While, in the past, immunisation coverage was 15% to 20%, which is very low compared to other states and counties, coverage for Greater Pibor Area is now 40%,” Thu says, noting that on a number of occasions health workers had to halt immunisation activities due to floods or security issues.</p> <p>“There are different kinds of conflict that can happen. When they do happen, we have to stop our vaccination team because there is a risk of them getting attacked. As a result, vaccinators and mobilisers cannot intensify their work consistently. Plus, there is the difficulty of regular ‘last mile’ delivery, due to geography and topography,” he adds.</p> <p>Thu says that UNICEF and partner organisations are doing all they can to deliver vaccines to remote areas.</p> <p>“We are using new technology that can store vaccines for a longer period, i.e. one month, without having electricity or power. We are also working with the partners to access vaccines and make sure they get into areas before the rainy season means they end up cut off with high water levels.”</p> </div> </div> </div> </div> </div> <p> <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork/improving-immunisation-rates-south-sudans-most-remote-region">Original article</a> </p><p>This article was originally published on <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork">VaccinesWork</a> </p><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-M7H54VD');</script><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-M7H54VD" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript></article>

A health worker vaccinating a baby at Munuki Health Center. Credit: Winnie Cirino

Pibor Administrative Area has some of the lowest immunisation rates in South Sudan. Santino Kiron Thewa, the local Community Health Director, says there are communities in the region that have not received vaccines since South Sudan got its independence 11 years ago.

“One of our challenges is the conflict that has destroyed several of our facilities, including cold chain, in different community areas,” Thewa says, adding that road accessibility is another concern.

“If there is fighting going on, you get scared. If I go [to an immunisation session], and the fighting reaches my home, who will look after the rest of my children when people flee the area?”

“In Labarak, there has been no vaccination of people as there is no cold chain and the health facility is not well functioning. This is due to the lack of roads. The only real access for health workers is to cross Jebel Boma’s Boma mountain, which is a risky endeavour.

Thewa suggests an alternative, saying, “If we have a chopper [helicopter] to transport health workers there, it will be good. We can even leave health workers there for up to seven days to provide health services and immunisation.”

A health worker records details in a vaccination card. Credit: Winnie Cirino — **A health worker records details in a vaccination card.**
Credit: Winnie Cirino

In counties like Legwangule and Gumuruk, some payams (administrative divisions) are far and don’t have health centres for people to access the vaccines. Mothers have to walk for one to two hours to reach the health centre and then make the return trip. It becomes riskier when conflicts break out.

“If there is fighting going on, you get scared. If I go, and the fighting reaches my home, who will look after the rest of my children when people flee the area?” asks Rebecca Juajing, a mother of six children living in Pibor.

“That’s one of the reasons why we [mothers] don’t take our children for immunisation on the days that we are meant to go. When there’s conflict, we often stay indoors for days on end. Another concern is that I am afraid of being attacked with my child while on the way to the hospital,” Juajing adds.

“The mothers in cattle camps don’t bring their children for vaccination. There is a need to reach out to them but, with the poor road network, general accessibility and insecurity, one needs to establish centres to protect both the medicines and the health worker.”

Twenty-nine-year-old Mali Korok, who also hails from Pibor Administrative Area, says that the existing hospital in Pibor almost has no purpose because it lacks the necessary equipment and medicines for it to function as a hospital.

“The hospital here is not like a regular hospital because it cannot treat most illnesses. There are many children suffering and dying from different diseases like tuberculosis but the hospital cannot treat them. Pregnant women also suffer a lot and sometimes die due to a lack of blood supplies,” Korok says.

Have you read?

Clean water for domestic use is another concern, Korok says: “There are very few water sources in residential areas. There is only one borehole in my area and everyone fetches water from it, which results in fights. Some people resign themselves to getting water from the stream, which is very dirty, undrinkable and makes one sick. We really need more boreholes, but also for the issue of the hospital to be addressed.”

James Chacha Konyi is the County Health Coordinator for the national non-governmental organisation, LiveWell, that is implementing an immunisation programme in Pibor. He says that while turnout for routine immunisation in towns has been good, it is poor in the rural areas.

“The mothers in cattle camps don’t bring their children for vaccination. There is a need to reach out to them but, with the poor road network, general accessibility and insecurity, one needs to establish centres to protect both the medicines and the health worker,” Konyi says.

He acknowledges that health workers are not operating in some payams due to the lack of facilities.

“We are using new technology that can store vaccines for a longer period without electricity or power. We are also working with partners to access vaccines and make sure they get into areas before the rainy season.”

A vaccinator administering vaccine to a child in Munuki Health Canter. Credit: Winnie Cirino — **A vaccinator administering vaccine to a child in Munuki Health Canter.**
Credit: Winnie Cirino

“There are no resources like solar fridges in those areas to store and maintain vaccines. With limited funding, it is difficult to cover those areas, which results in counties like Nanaam county being completely cut off,” Konyi explains.

He adds that to encourage mothers to complete their children’s immunisation, Livewell does provide incentives. “We have some activities that encourage them [mothers] to come to the facility to complete immunisation, especially for the last dose of Penta 3. At the end, we give mothers things like mosquito nets and we find that it does help,” Konyi says.

While immunisation rates in Pibor have been poor, Nay Myo Thu, Cold Chain Specialist at the United Nations Children Emergency Fund (UNICEF) in South Sudan feels some progress has been made this year.

“While, in the past, immunisation coverage was 15% to 20%, which is very low compared to other states and counties, coverage for Greater Pibor Area is now 40%,” Thu says, noting that on a number of occasions health workers had to halt immunisation activities due to floods or security issues.

“There are different kinds of conflict that can happen. When they do happen, we have to stop our vaccination team because there is a risk of them getting attacked. As a result, vaccinators and mobilisers cannot intensify their work consistently. Plus, there is the difficulty of regular ‘last mile’ delivery, due to geography and topography,” he adds.

Thu says that UNICEF and partner organisations are doing all they can to deliver vaccines to remote areas.

“We are using new technology that can store vaccines for a longer period, i.e. one month, without having electricity or power. We are also working with the partners to access vaccines and make sure they get into areas before the rainy season means they end up cut off with high water levels.”