Integrated Public Health Teams: Helping Sudan Move Forward on Polio Transition

Haffiya Abdalla

An important milestone in integrating 4 key public health programs was reached last week in Khartoum, Sudan. Staff from 4 critical areas of state-level health care – poliovirus eradication, immunization, health emergencies, and health system strengthening – met to operationalize their work across all 18 states in Sudan as integrated public health teams. This is a vital step in the polio transition agenda and in moving towards integration to ultimately serve the health needs of people and communities.

“This is a critical development for Sudan, which was responding to a poliovirus type 2 outbreak in 2020 and 2021. After a strong response by national authorities with support from WHO, UNICEF, and other partners, the country is looking to integrate disease surveillance functions and improve immunization for all vaccine-preventable diseases. WHO policy direction in Sudan is to support in building resilient health system to advance universal health coverage and address health security threats,” says Dr. Nima Abid, WHO Representative to Sudan.

According to the WHO a polio transition mission took place in December 2019 by members of the Regional Working Group on Polio Transition, WHO headquarters’ Polio Transition team, and the Polio Transition Independent Monitoring Board. As an outcome, a comprehensive plan was developed to operationalize the integrated public health teams approach in Sudan as an interim measure to sustain WHO support for essential polio and other public health functions.

“In the operationalization of integrated public health teams, the functions of technical field staff of polio, health emergencies, Expanded Program on Immunization, and health systems strengthening are broadened in a way that each technical staff covers all the priority public health functions defined by the country,” explains Dr. Mohammad Taufiq Mashal, Medical Officer at the WHO Sudan country office working on polio eradication and transition.

The WHO field technical officers’ network, which includes 18 health emergency-supported officers, 13 polio officers, and 6 health system officers, will be transformed to make a network of public health officers, with integrated functions in areas of disease surveillance, immunization, and outbreak response.

There are 3 main priorities for integration planning:

  1. Integrating and strengthening acute flaccid paralysis, vaccine-preventable disease, and Early Warning Alert and Response System (EWARS)
  2. Strengthening disease outbreak preparedness and response capacities
  3. Strengthening the essential immunization system

With years of public health experience to draw from, the newly oriented public health officers will begin their roles in the second quarter of 2022. Close monitoring and evaluation are taking place to gather lessons and make any adjustments to implementation. As part of broader health systems strengthening and polio transition, the aim is to hand over these functions to Sudan’s Federal Ministry of Health in 2 years.

This is the first workshop on integrated public health teams in the Region and lessons learned will be used to operationalize the initiative in other targeted countries.

Despite the impressive response, partners are urging continued vigilance, stating that strong disease surveillance and continued vaccination are the only ways to ensure that Sudan can confidently maintain polio-free status.

To ensure that children under-5 years old have optimal immunity against the virus, effective social mobilization and communication activities played a vital role in generating information and acceptance for polio vaccines. The activities were implemented in both rounds across 18 states to ensure the communities were aware that the polio vaccine could reach every child. The campaign resulted in the high acceptance of the vaccine and low levels of resistance.

Moreover, the technical and financial support from the Global Polio Eradication Initiative, a consortium that includes Rotary International, the US Center for Disease Control and Prevention (CDC), the Bill & Melinda Gates Foundation, GAVI, the Vaccine Alliance, WHO, and UNICEF led to a swift response to the outbreak to protect children at risk of polio and prevent further spread of the virus.

Sudan’s last wild polio case was reported in March 2009 and the country was announced polio-free in 2015 by the WHO.

The FMOH, alongside its partners, WHO and UNICEF, are working to implement recommendations from an interim Poliovirus Outbreak Response Assessment (OBRA), conducted in September and October 2021, which are focused on maintaining the level of surveillance required to rapidly detect any new emergence of the virus.

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