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Mar 28, 2024   |   Blog Post

Progress through Motion: Enhancing Polio Sample Transport in South Sudan

A motorbike driver transporting AFP samples in Pibor County, South Sudan-Photo Credit: Godfrey Vuni

By Ronald Ngeno

Program Communications Manager

By Godfrey Vuni

Program Officer, Access for Humanity

The battle against polio is a race against time. Prompt diagnosis is critical to halt the disease’s spread and ensure affected children receive necessary care. However, transporting samples from remote areas in South Sudan to the capital Juba, and then to the international laboratory in Uganda, poses a significant challenge. Samples often endure long journeys and are exposed to scorching temperatures in areas lacking cold chain equipment.

A 2022 assessment by VillageReach for the Global Polio Eradication Initiative (GPEI) pinpointed several bottlenecks in sample transportation:

  • Delays due to poor road conditions, flooding, and conflict.
  • Gaps in the training of health surveillance officers.
  • Lack of timely reimbursements for those transporting the samples.
  • Lack of timely pre-positioning of sample collection kits and carriers.

Partnership Solutions

To tackle these challenges, the South Sudanese Ministry of Health (MoH), VillageReach, Access for Humanity (AFH), and the World Health Organization (WHO) designed the following solutions focused on 12 counties (see map above) where Access for Humanity was already active in community-based surveillance for polio:

a) Training program
A training of trainers program was implemented for 27 county and state polio surveillance officers. Additionally, 34 WHO field assistants and 73 community-based surveillance field assistants received training on all aspects of acute flaccid paralysis (AFP) specimen collection, cold chain storage, and transport. This improved case detection, reporting, and sample collection.

b) Sample transport
In 2023, 212 AFP samples (for 106 patients) were transported directly from communities to the county level, utilizing all available local means of transportation. From the County level, samples went by road or via UN Humanitarian Air Service flights to Juba. AFH reimbursed expenses for field surveillance officers and stepped in to facilitate the transport of samples to Juba’s National Public Health Laboratory when needed.

c) Supplies Management
The project ensured the availability of sample carriers (152), collection kits (149), and remote temperature monitoring devices (U-TRIX log tags) at local levels, preventing stockouts and loss of samples.

Successes and Achievements

These solutions aimed to improve human resource capacity and provide tools to support sample timeliness and quality, with the following successes and achievements noted:

  • Improved communication, coordination and collaboration among the surveillance officers in the 12 Counties.
  • Frontline surveillance officers and those at the sub-national level have gained increased capacity to carry out their work.
  • Improved availability of testing kits and sample carriers at the local levels. There were no reported stockouts, no loss of samples, and all AFP samples were collected on time, within 14 days after the onset of paralysis.
  • Significant reduction in time spent transporting polio samples from the community level (where the samples are collected from patients) to the county level. Unlike traditional methods, this project gathered samples directly from communities, rather than health facilities.
  • AFH conducted five stakeholder advocacy meetings in three States and one administrative area to strengthen coordination and explore strategies to integrate AFP and Environmental Surveillance for polio with other disease surveillance systems.

In the 12 project counties, transport was very rapid, averaging 0.4 days in 2023, with 90% of samples achieving the 1-day target through the County level. This segment of transport, for which the project was directly responsible, is shown in red above.

Challenges Remain

Despite these successes, the threat of polio persists, as seen in December 2023 (the final month of the project) when a polio outbreak occurred in South Sudan and two people tested positive for polio. South Sudan’s tough environment means creative solutions are still needed to keep samples cold on long journeys. Regular training for health workers is also important.

Specifically, other means of transportation at the local level are needed (such as canoes) along with cold chain equipment to maintain sample quality along the way. In addition, insecurity in some counties makes it difficult to use motorcycles for sample transportation – thus the use of vehicles and security personnel for safety in transit would help. Further, the 3-day target to the international lab continues to be difficult to achieve, due to irregular and infrequent flight schedules (sometimes only once per week to Juba). This may delay samples, even though local transportation up to the county level has sped up.

Transition and Future Projects

In January 2024, Access for Humanity, with support from VillageReach, held a transition workshop for the project, where it was pointed out that six counties (out of the 12) will benefit from a new project through World Vision. In all the remaining counties, the Ministry of Health and WHO will continue the good work that has started.

The Future is Polio-Free

By prioritizing logistics, empowering communities, and investing in sustainable solutions, we can pave the way for a future where polio is a relic of the past and no longer a threat.


Contact Information

For more information about the Polio Lab Sample Transport program in South Sudan, contact Dr. Hakim Aquila, Program Lead at Access for Humanity (hakim@accessforhumanity.org), or Mr. Dauda Majanbu, Senior Manager, VillageReach (Dauda.Majanbu@villagereach.org)

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