Spotlight on missed children
In the world’s newest country, the proportion of missed children is less than 5%. However the volatile security and population movements that results still presents a significant threat to the Horn of Africa region. The three States bordering Northern Sudan - Unity, Warrap, Northern Bahr El Ghazal – are the most vulnerable to conflict, together with Jonglei and Upper Nile, which continue to have internal tribal clashes (see Figure SSU1).
Why are we missing children?
The overall proportion of children missed in S. Sudan has been reduced following the mass movement of returnees in February. Still, internal migration and widespread population movement into neighboring Ethiopia presents an operational challenge for reaching every child with OPV. This presents a significant risk of an outbreak should a virus be detected.
Accessing the widely dispersed population in the context of conflict, flooding and poor infrastructure is now the biggest challenge. Air transport is often the only option to deliver vaccines and necessary supplies to the states, but this is not a viable option to for transporting vaccinators. This is one of the reasons why over 50% of missed children in S. Sudan are missed due to teams’ inability to reach homes (see Figure SSU2). However, many vaccinators work against the odds, for example risk their lives crossing overflowing rivers in order to reach children.
The high costs of service delivery also present a significant challenge for the new Government. Government spending for polio has been largely achieved through GAVI grants, and the country currently has no cost-sharing mechanism to support polio eradication or immunization programmes going forward. Therefore, a heavy reliance on GAVI and the technical agencies will need to continue into the foreseeable future.
The reasons for missed children in South Sudan are split almost evenly between children not accessed, and children not available when vaccination teams visit. Over 45% of children missed in November were due to “child not available.”
The lack of social data available to the programme means we simply do not know where children are when they are not at home. It is also likely that children who could be easily recovered are missed due to inadequately trained health staff who may not be actively searching for them. The planned KAP study will be critical to ensuring communication plans effectively address reasons for missed children.
New population groups settling into areas that are difficult for health staff to access, together with an inadequately trained pool of health workers, means that many children are missed due to poor service delivery.