Restoring healthcare in areas hardest hit by conflict

The World Bank and UNICEF have partnered to create demand for and deliver health services in Jonglei and Upper Nile.

Richard Ruati
People sitting in a tent
18 April 2020

Wau Shilluk, South Sudan - Lucia Nyalwak Ajak, a 34-year old mother, happily arrives at the meeting point under a giant tree with her three children, aged 3, 7, and 11 years old and smiling spontaneously. She cannot hide her joy of having her children vaccinated but getting there was not smooth.

Lucia says, “this support should continue a long way in saving the lives of children and mothers and allowing community members to enjoy a life of good health.”  

Wau Shilluk Primary Health Care Centre (PHCC) is more than 30 kilometres from Lucia’s home, Owech village in the north-eastern corner of South Sudan. The only way for her and her children to get there is by foot through the dense but lush bush under the scorching sun braving insecurity. But that is what mothers do to protect their children from life-threatening diseases.

A mother walking with her children
Lucia Nyalwak Ajak and her three children in Owech village

She wouldn’t have started on the four-hour life-saving journey, if it wasn’t for the home visit from social mobilizers, talking about the importance of immunization.

88 per cent of the population in South Sudan live in rural areas, and 56 per cent live five kilometres or more from the nearest health facility, which hamper access to health services significantly. It also affects people’s health-seeking behaviour. Unless there is a clear benefit from making the journey, people won’t embark on it. Therefore, outreach activities in communities are an essential part of the World Bank and UNICEF health programme.

A boat with supplies
A boat with medical supplies from UNICEF delivered to the Primary Health Care Centre in Wau Shilluk, through UNICEF's partner IMC.

Local health officials are impressed with the progress. “After the programme started, we have seen a substantial increase in the number of community members accessing healthcare, I’m quite impressed,” says Nyibec Adieng Kur, Medical Assistant at Owech Primary Health Care Unit.

Not everyone makes it. The long trek can take the toll on a healthy person, let alone someone suffering from malaria, acute diarrhoea and pneumonia, which are some of the most common diseases affecting people in the area.

“I’m facing many difficulties as an asthma patient ; it took me more than one hour on foot to get here. There is no transport, and a sick person finds it difficult to move to the nearest health centre,” Says Kalthum Jak, whom we meet at the health centre.

However, the earlier you seek help, the better. The most common sicknesses can be easily treated, and UNICEF is ensuring medical supplies are available at the health facilities. Nyayiid Obull Ayiig, a mother of two, can testify to that. When her one-year-old baby girl fell ill with malaria, she started on the 20-kilometre-long journey with her daughter in her arms.

“I am thankful for the support from UNICEF and partners for bringing health service closer to us”. I am also thrilled that health services are free. Because of that, my child was able to get medical attention very fast, and my baby was saved,” Nyayiid says.

A woman walking with a cool box
Health worker Regina in Owech village where she is vaccinating children. The Vaccines are carried in a cool box

South Sudan is one of the most dangerous countries to be a child, and lack of access to health care is one of the main reasons. 96 out of 1,000 children die before their fifth birthday. 75 per cent of these deaths could have easily been prevented. Some even die before they have seen daylight, or they are born, but their mother is no more. Skilled hands attend only eight per cent of births in South Sudan.

“That is now changing in the area where we have rolled out the health programme,” says UNICEF Health Officer at Malakal Field Office, Dr Emmanuel Lual. “The awareness created by health workers in the communities has increased the numbers of antenatal care visits, and we see more women delivering in clinics.”

As much as getting more people to come to the clinics to get help and save lives, the World Bank and UNICEF are also aiming to bring more services to the communities, preventing long journeys for the sick. One example is immunization and health worker Regina Daniel who is going from door to door with a portable cold box immunizing children. Seeing the change has “woken us up,” as several community members put it and are committed to promoting health services.

The World Bank in partnership with UNICEF and its implementing partner International Medical Corps (IMC) is rolling out the ‘provision of healthcare at the community level’ project in the three counties of Akoka, Malakal, and Panyikang in Upper Nile. A total of 100 community health workers will be selected from 10 bomas [village level] and spread across the three counties to create demand for and improve access to quality health care.