Cold chain supplies and trained workers boost immunization rates in Upper Nile

A centralized cold chain system, vaccine supplies and trained workers help boost immunization rates among children under five in hard-to-reach areas of South Sudan.

Robin Giri
A child gets the oral polio vaccine
17 March 2022

The wailing of young children rings through the corridors of the outpatient department of the Malakal Hospital in Upper Nile State. As we get closer to the door marked “EPI room”, the screams get louder. Inside we find a handful of mothers, holding a blue card and cradling their children as they wait in turn.

“Nyan Chol?” says Diu Aknei, reaching into a large paper box as he retracts a disposable syringe. Diu is the vaccinator today, but that is not his only role here. He is also the County Cold Chain Officer in this area and responsible for the safe transport, storage and delivery of vaccines to other vaccination centres in and around Malakal.

Nyan Chol, a young mother, stands up with her two-month-old daughter Khamisa in her arms, and moves to the bench in front of the vaccinator. She hands him the blue immunization card and Diu carefully scans it and nods.

Without another word, Diu sets down the disposable syringe and instead retrieves a vial of the oral polio vaccine and moves towards the child. With that administered, he then moves to the syringes and with mechanical clarity, he administers two other doses of different vaccines and turns away, the child now bawling at the top of her lungs.

A child about to get vaccinated.
Sarah Bol has brought her nine-month old son to the EPI centre in Malakal to get vaccinated.

“She is two months old so I gave her the first dose of the oral polio vaccine. I also gave her the first dose of DTaP (diphtheria, tetanus, and whooping cough) and her first dose of the PCV13 (pneumococcal disease),” says Diu almost business-like as he throws the used syringes into the safe disposal box.

Diu motions with his hand and Nyan gets up and exits with her baby, and another woman moves towards the now empty bench with her child.

Diu turns away and gets back to business, going through the same motions with the new mother, checking the card and administering the required vaccines to the child.

The expanded programme for immunization (EPI) is the basic but crucial vaccine delivery programme for children under five in many countries, including in South Sudan. Through this programme, children receive the required doses of vaccines at carefully timed intervals, so that they are protected against disease and infection throughout their lives.

“We are very happy with the increase in numbers of mothers coming in with their children to get them vaccinated. We can say that immunization rates in Malakal and other areas have increased by almost 50% from a few years ago,” says Diu.

Diu with a vaccine carrier
Diu Aknei, is a County Cold Chain Officer in Upper Nile State.

This was not the case just two years ago, when immunization rates in Upper Nile and Jonglei States were among the lowest in the country. Repeated rounds of subnational violence beginning in 2013 through 2017 destroyed many government facilities, including health centres and critical medical equipment and supplies.

To counter this, a health programme implemented since 2018 by the Ministry of Health, the World Bank and UNICEF, has been providing essential child health services to the most hard-to-reach populations in Jonglei and Upper Nile States.

The World Bank-financed project supports the EPI programme by supporting the establishment of a centralized cold chain centre in Malakal and vaccine carriers and training of health staff. The programme also supports vaccine deployment throughout the country and the training for community mobilizers to increase awareness among mothers, and to increase health seeking behaviours among communities.

“We are hopeful that this trend will continue and children will be able to receive the required vaccines on time. That way less children will die from simple diseases,” says Diu as he moves to the next mother in line.

The central cold chain system in Malakal funded by the World Bank.
The central cold chain system in Malakal. Vaccines are stored safely here and distributed to immunization centres whenever needed.

The Ministry of Health, the World Bank and UNICEF want to build a broad coalition of partners and donors to support additional investment in the health sector in South Sudan. Meanwhile, the programme continues to support the maintenance of the cold chain systems and related supplies, and trainings for health workers and community mobilizers.

The safe storage and delivery of these lifesaving vaccines to children in hard-to-reach communities will reduce common childhood illnesses and vaccine preventable deaths, and ultimately a lowered child mortality rate in South Sudan.