6 Ways South Sudan Is Using Data to Tackle Its HIV Epidemic—and Prepare for Future Pandemics
I work in South Sudan for IntraHealth International. A lot of people might not realize why collecting and using data efficiently are so important for health services here. But the data we collect inform everything we do, from figuring out how many people need antiretroviral treatment and how many health workers are needed at a specific health facility to helping the government and other funders determine how much to spend on public health services in South Sudan in a year.
For the past 15 years, IntraHealth has been helping the South Sudan government create better systems and improve health services.
Here are some of our approaches I’m most proud of—because they have changed health care in South Sudan and will have lasting impact on the future of health care in the country.1. The latest tools.
Seven years ago, data about health services in South Sudan were being sent by email at the county and state levels and were then transmitted via Excel spreadsheet. Now, health officials can access data in real time.
We’ve helped achieve this by working with our government colleagues to use the right data collection tools in facilities and communities, including customizing them for the District Health Information Software 2 (DHIS2) we rolled out for data reporting and management. This has been a critical component to HIV services and program funding in the country.
We helped South Sudan transition from DHIS1.4 to the web-based DHIS2, an open-source web-based health management information system that allows us to capture more data in a streamlined way. We rolled it out in all ten states, 80 counties, and about 84 facilities that provide HIV services. We’ve worked with our partners like The Global Fund, United Nations Development Programme, World Bank, World Health Organization, and Gavi to implement this system and make sure it can function properly for everyone.
2. Surveillance and surveys.
Before we started conducting surveillance, the data were scarce. But then we worked with the Ministry of Health to conduct key population surveys, which led to changes in our approaches.
When the data showed high infection rates among female sex workers (38% in Juba, for example), we improved our HIV services for this key population.
The data we collected helped us scale up the E2A project from three cities to six.The data also led The Global Fund to increase funding for the country to prioritize key population interventions. Right now, we are supporting the key population program to make sure these women are receiving services. And we are scaling up to other towns.
We are also helping the ministry conduct routine monitoring in 59 facilities and are using those data in conjunction with program data for country planning, projections, and estimations of the people living with HIV for UNAIDS Global AIDS monitoring reports.
3. Site-level field supervision.
We worked with the President's Emergency Plan for AIDS Relief (PEPFAR) to recruit six local field officers and sent them to health facilities so they can supervise the program and use data to support decision-making at the facilities. This program showed significant success, so we scaled it up. Right now, we have about 22 field officers and we just finished recruiting four more who are going through intensive orientation and training.
We use the granular site management (GSM) system—an intensive onsite program data review—and quality improvement approaches to improve health workers’ performance, grow the HIV program, and improve the quality of HIV services. The field officers work with their teams to collect data daily and submit them on a weekly basis to our staff who generate weekly and monthly dashboards. These are used to review performance and create improvement plans.
4. Institutional-level support.
We provide this to the Ministry of Health and The Global Fund country coordinating mechanisms, and the Research and Ethics Review Board. We worked with The Global Fund to set up the county coordinating mechanisms and recruit staff to oversee the secretariat. Now the mechanisms are functioning and providing crucial oversight.
Turnaround time for requests was 2-6 months, but now it’s 2-4 weeks.
We also noticed that there was a weak ethics review board in South Sudan was struggling greatly. They reviewed all the human research conducted in the country and there were a lot of delays. So we helped strengthen the board by making sure it was fully reconstituted, members were trained and active, and the secretariat could function to its full potential.
Turnaround time for requests to the review board was 2-6 months, but now it’s 2-4 weeks.
It’s very important for any country to have this, given human subject research issues.5. South Sudan Public Health Institute.
We are currently working to establish and complete a strategic plan for this new institute, which is like the US Centers for Disease Control and Prevention, but in South Sudan. It’s a key pillar for disease prevention, detection, and response. This is a historic project for the country and it’s something we will be part of for many years. It will help shape the future of global health in South Sudan.
6. COVID-19 pandemic response.
When South Sudan’s first case of COVID-19 was identified in early April 2020, we immediately joined the country’s pandemic response.
We seconded staff to support the national steering committee and helped establish the COVID-19 data management unit, COVID-19 data management technical working group, and the COVID-19 webpage on the Ministry of Health’s website to provide real-time updates on COVID-19 to key stakeholders. Using the DHIS2 surveillance tracker—the same software that we were already using to strengthen HIV data collection and use—we are now capturing COVID-19 data for testing and vaccines.
Strengthening National Capacity for Integrated HIV/AIDS Health Data Collection, Use, and Dissemination in Support of an Evidence-based Response in South Sudan is funded by the US Centers for Disease Control and Prevention.