Southern Sudan
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Tuberculosis (TB) is a major cause of morbidity and mortality in Sudan. The World Health Organization (WHO) provides national data estimates, which include all of Sudan, and vary slightly from national data reported for Southern Sudan. In 2007, WHO reported the incidence of all forms of TB at an estimated 243 cases per 100,000 population; estimates provided by USAID for Southern Sudan were 228 cases per 100,000 population. In Southern Sudan, an estimated 18,500 people develop TB, and 5,300 die of TB annually. In 2007, the National TB Control and Leprosy Control Program, Government of Southern Sudan (NTBCLP/GoSS) reported a total of 4,738 TB cases, of which 2,513 were new sputum smear positive (SS+) TB, the infectious type of TB. The DOTS (the internationally recommended strategy for TB control) case detection rate is still very low, at only 19 percent in Southern Sudan, which was reached in 2006. However, treatment success rates are excellent, at more than 80 percent, which were reached in 2005, and the default rates remain below 5 to 10 percent in most cases. Although the exact incidence of HIV/AIDS among TB cases is not known, HIV prevalence appears to be on the rise. Data from limited population surveys show HIV prevalence rates range between 1 and 8 percent among the general population, with higher rates (up to 25 percent) found in border towns. In Southern Sudan, multidrug-resistant (MDR) TB cases account for around 1.9 percent of new cases and usually occurs among defaulters and relapse cases.
The TB epidemic is an outgrowth of a long-standing war, which has resulted in poverty, malnutrition, and a large number of displaced populations and refugees. Destruction of health infrastructure, lack of microscopic services, and displacement or lack of health personnel have also contributed to the epidemic.
The recently installed Ministry of Health (MOH) and NTBCLP have yet to fully establish themselves and face the challenges of developing health policy and services virtually from scratch. TB care in Southern Sudan still relies entirely on the work of nongovernmental organizations (NGOs), with technical assistance from several international partners.
USAID Approach and Key Activities
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The Mission initiated TB activities in 2004. In fiscal year (FY) 2008, USAID provided $595,000 to Sudan to implement TB activities, in close collaboration with the NTBCLP and the GoSS. USAID provides support to the NTBCLP through the Tuberculosis Control Assistance Program (TB CAP), which is implemented by the Tuberculosis Coalition for Technical Assistance and managed by the KNCV Tuberculosis Foundation. In FY 2008, USAID provided technical support to the NTBCLP, focusing on technical support for TB policy, DOTS expansion, capacity building, and strategic information capacity. Currently, USAID assists 17 NGOs that provide TB care in 38 primary health facilities throughout all 10 states of Southern Sudan. USAID also supports the GoSS and the Southern Sudan AIDS Commission (SSAC) to provide strategic leadership in health, sanitation, and HIV/AIDS. Importantly, USAID assistance to combat TB contributes toward the provision of high-impact health services as a tangible peace dividend, supporting the 2005 Comprehensive Peace Agreement. USAID assistance includes support for the following activities:
- Expanding and enhancing DOTS services
- Building the capacity of the NTBCLP to manage and monitor the TB program in Southern Sudan
- Supporting the implementation of community-based DOTS (C-DOTS)
- Renovating laboratories and expanding laboratory network to improve TB diagnosis and treatment
- Strengthening the central TB laboratory in Juba so it can carry out regular and effective laboratory quality control and assurance; and supporting laboratory networks for quality assurance
- Providing technical support to the NTBCLP to establish effective coordination mechanisms between donors and other partners such as the Stop TB Coordination Body and the TB-HIV/AIDS Coordination Mechanism
- Integrating TB and HIV/AIDS services at the primary health care level
- Improving the capacity of state-level supervisors to manage and supervise TB activities
USAID Program Achievements
The program is in its fourth year, and USAID’s assistance and support have helped address TB prevention and control in Southern Sudan through the following accomplishments:
- Increased the number of health facilities providing DOTS from 15 in 2004 to 38 in 2007
- Provided technical support for the development of the National TB Strategic Plan for 2007–2011
- Provided technical support for establishment of the National TB Control Program and effective
coordination mechanisms
- Trained a total of 55 health workers (36 on TB microscopy and 19 on DOTS) in FY 2007, with 61 planned for FY 2008
- Provided funds for the construction of a National Tuberculosis Reference Laboratory in Juba and supported the
rehabilitation of five state TB laboratories
- Provided technical assistance, essential drug treatments, and laboratory supplies to support WHO programs
- Trained 124 health staff in the latest TB testing, treatment, and case management at United Nation sites in the former garrison towns, an important step for harmonizing the different TB treatment regimens used in the north and south, thus preventing the spread of MDR-TB
- Conducted DOTS trainings that emphasized the active participation of women health workers to enhance community-based care, with the aim of increasing the number of women health care workers providing TB care
- Supported the NTBCLP, in collaboration with other major partners, and the formation of the Stop TB Partnership, and HIV/AIDS-TB partnership coordination mechanisms, which now meet quarterly
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
Partnerships
USAID works in collaboration with the MOH/GoSS, the SSAC, and nongovernmental partners (both international and Sudanese). Key international partners include WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund is supporting six NGOs to expand the TB program and implement TB-HIV/AIDS collaborative activities. The United Nations Development Programme, Maltesa (a German NGO), the German Leprosy and TB Relief Association, UNICEF, and Merlin also support the strategy of the Stop TB Partnership. Sudan received funding from the Global Fund in Round 2 (2004) for $14.5 million, Round 5 (2006) for $15.4 million, and Round 7 (2008) for $6.2 million for Phase One of the program. In 2009, Sudan received $18.0 million in funding in Round 8 for improving the quality of DOTS and expanding TB services, especially to war-torn areas.
May 2009
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