South Sudan: Rethinking Covid-19 Response

By John Apuruot Akec*

Given the speed of the virus, there is a need to review our national Covid-19 response strategies in order to accelerate our readiness and gain a head start on the virus.

Just in one month, our country has moved from 4 Covid-19 cases to 49 cases, and still increasing. And judging by the steep rise in numbers of Covid-19 cases elsewhere, such as seen in Somalia, where the number of cases shot up sharply from just 4 cases and no deaths at the beginning of April, to 722 cases and 32 deaths by the first week of May 2020; one can estimate that South Sudan could see the number of cases rising to 4,600 by June, and possibly 460,000 by August or September 2020 (if ever we are able to test and report them). This calls for a pause and rethinking of our current strategies for combating coronavirus pandemic.

Firstly, in order to measure the level of prevalence of the virus in the community, there is a clear need to move quickly to widespread testing of at least 500 cases per week at selected clinics and primary health care centres across Juba city. This was agreed by the High Level Taskforce on Covid-19 some three weeks ago. Once the 500 tests per week target has been attained, the testing needs to be expanded to include screening of healthcare workers, UN agency employees, and members of the organised forces. This will ensure that members of the above institutions that are actively engaged in providing essential services during the lockdown, do not themselves become the vehicles of transmission of coronavirus in the community. The realisation of widespread testing calls for mobilisation of resources for purchasing vital equipment, expanding lab testing capacity, provision of protective equipment for frontline health sector workers, and and hiring of additional healthcare staff.

Lack of equipment and personnel may be partly blamed for the delays. However, chronic institutional incapacity, challenges in the allocation of scarce resources, and questions regarding transparency within and between key stakeholders could be undermining the trust in and effectiveness of the High Level Taskforce. Moving forward, these hindrances require addressing in order to remove the bottlenecks.

Second, there is a need to develop clear guidelines for the management of positive cases and quarantining regimes and protocols in a way that speaks to our different scenarios and circumstances. Current quarantining practices involving compulsory removal of positive cases for isolation away from their families are creating fear and stigma in the community. Increasingly, people are getting discouraged to report Covid-19 cases, and many suspected individuals tend to reject testing for fear of social consequences and fear of mistreatment in the hands of authorities.  It is becoming more apparent that current procedures are a result of adoption, in ad hoc manner, of quarantining procedures that are nothing more than mechanical mimicry of what the developed and highly resourced countries are pursuing, while stopping short of transparency culture prevalent in those jurisdictions that are being uncritically emulated.

Third, preparedness in terms of raising testing capacity, and capacity to treat critical cases, is on standstill. At best, some preparations may be taking place behind the scene in an atmosphere bereft of transparency. This is a point of departure from the western systems that are being copied. Citizens and stakeholders deserve to be furnished with all facts on how the country is preparing to fight the pandemic, including highlighting areas of challenges.

Finally, coordination and distribution of roles (the role of High Level Taskforce on Covid-19, technical committees of the Taskforce, the Ministry of Health, other line ministries involved, NGOs, business community, academia, and civil society all need to be clearly defined. While contributions are streaming in cash and in kind, few know how much has been contributed overall, and whether or not there are gaps in provisions.

In addition, the High Level Taskforce currently spends much time approving the daily cargo flights for different organisations, instead of delegating that role to the relevant public institutions, NGOs, and civil society. Left unchecked, the work of the Taskforce could unwittingly combine the roles of the lawmaker, prosecutor, judge, and jury. The role of a government body such as High Level Taskforce on Covid-19 is to make high level policies and delegate their implementation to executive agencies within and outside the government, which is in line with the principle of separation of powers. Furthermore, social policies requiring empathy and compassion are best outsourced to civil society, organised interest groups, and non-profit sector for implementation.

To conclude, the work of High Level Taskforce on Covid-19 could be improved immensely by considering and removing the bottlenecks enumerated above.  

*Professor John Apuruot Akec is the Vice Chancellor of the University of Juba, South Sudan; and the Chair of University of Juba Covid-19 Response Committee.