28 March 2018

South Sudan: Lessons From Darfur - How to Deliver Healthcare in Insecure Regions


So far this century, Sudan's Darfur region has been known for all the wrong reasons.

The conflict that broke out in 2003 has taken thousands of lives and forced millions from their homes, leading to the United Nations and African Union deploying a large peacekeeping mission.

Disease prevention in an insecure environment

In recent years the conflict has subsided, making it possible for some healthcare services to be revived. One disease that is widespread is trachoma, a painful eye infection which, if untreated, often leads to complete sight loss.

One of 17 neglected tropical diseases (NTDs), trachoma is the leading infectious cause of blindness globally. Yet it can be controlled through large-scale treatment programmes, known as mass drug administration (MDA).

Delivering a new programme of this scale across Darfur was always going to be challenging. This is not just because the region has been so recently scarred by conflict, but also because it required a huge number of donated drugs and a large trained workforce of health professionals and volunteers to administer them.

Now a year into the programme, we've been reflecting on the lessons we've learned about disease prevention in regions such as Darfur.


Often periods of conflict wipe out routine data-gathering mechanisms, with any available health data being unreliable and patchy. Without accurate disease maps, programmes will be poorly targeted and ineffective.

This was certainly our experience in Darfur. Top of FormBottom of FormTo tacTFirst we needed to know where those affected by trachoma were living, but after years of conflict the data just wasn't robust.

In 2015, with the agreement of the Federal and State Ministries of Health and as part of the UK Aid-funded Global Trachoma Mapping Project, Sightsavers supported the mapping of trachoma across Darfur. This took a number of months and required investment, but by basing the resulting treatment programme on up-to-date data, it was given the best chance of success.


Once data is available, it's essential to be ready to scale-up programmes and deliver results. This requires being alert to opportunistic partnerships and open to learning from organisations well-versed on post-conflict working. The process from analayis of the mapping data to delivery of the first treatments in Darfur took just a matter of months.

We worked with local minsitries of health and community groups across Darfur to deliver the region's first ever trachoma MDA, which was completed in September 2017 and funded by the END fund. The Darfur campaign covered an area as big as France - providing 2.55 million treatments over a 12 month period.


So often conflict can decimate a region's healthcare workforce, as skilled professionals are diverted away from routine treatment programmes or forced from the area altogether.

For trachoma in Darfur, our solution was to use community volunteers to deliver treatments. We trained 3,800 community health volunteers, 90% of whom were women.

These volunteers were trained not only to administer the drugs in their local area, but also to sensitise the community in advance and counsel those wary of treatment.

The MDA was carried out house-to-house, which added to the volunteers' workload - particularly in the large camps for displaced people around Darfur's towns and cities - but ensured everyone who needed treatment got it.

Recruiting volunteers actually turned out to be straightforward. After years of turmoil people were keen to receive training. By empowering local communities, they are able to continue with trachoma control measures and other health interventions, even when external support is intermittent.

The role of the volunteers, supervised by disease experts, was the main reason the programme reached so many people.


The trachoma MDA programme in Darfur is a success story.

For the first time, hundreds of thousands of people have been treated for trachoma, preventing them from experiencing a lifetime of pain and visual impairment.

It is also a success because communities that have been displaced and had their lives turned upside down have been strengthened by the knowledge that they are solving the trachoma problem themselves.

Of course no insecure region is the same as another and each healthcare programme must be tailored to its specific disease. But the approaches taken in Darfur could be adapted and applied in other similar situations.

The second round of treatments will start later this year with funding from the World Health Organization's Expanded Special Programme for the Elimination of NTDs and Sightsavers. Find out more at www.sightsavers.org

Simon Bush is Director of Neglected Tropical Diseases at NGO Sightsavers.

Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.


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