The United States Agency for International Development has responded to 'Healthcare in Crisis', a series of reports published by Radio Tamazuj a month ago about drugs shortages and other challenges in South Sudan's health sector as well as the interventions by various donors to improve the situation.

In a written response, USAID claims that there are some inaccuracies in a report in the series titled 'Why South Sudan faces a critical drugs shortage'.

Radio Tamazuj maintains in its report that the Emergency Medicines Fund (EMF), supported in part by USAID, was allowed to expire without anything in place to replace it, initially. Moreover, we have reported that follow-on procurement mechanisms are providing only some of the drugs on South Sudan's essential medicines list

USAID in its response downplays the gaps in the drug supply that have led to widespread and widely reported shortages this year. Nonetheless, the donor agency acknowledges that “donors alone cannot fully fund essential medicines for South Sudan.”

Their response in full is published below. To share your own comments on this issue, please contact us.

USAID response to Radio Tamazuj series: "Healthcare in Crisis":

USAID appreciates the recent series “Healthcare in Crisis,” published by Radio Tamazuj, which highlights many of the ongoing efforts to address the numerous challenges facing the health sector in South Sudan. Nevertheless, USAID would like to provide the following additional information to clarify aspects of our support and to correct some inaccuracies reported in the articles.

Response to 'Why South Sudan faces a critical drugs shortage'

Overview of USAID support:

• In collaboration with the United Kingdom and Norway, USAID established an Emergency Medicines Fund (EMF) for a one-time procurement of essential medicines and health commodities to cover the entire country for one year through the USAID-managed DELIVER project (John Snow Inc.). This helped provide life-saving medicines to all parts of South Sudan, including areas held by the then-opposition and other areas affected by conflict. The activity officially ended on March 31, 2016.

• Following the closure of EMF, USAID is working with DFID, other donors, and the Ministry of Health, through the Health Pooled Fund 2 (HPF2), to ensure the continued availability of essential medicines in the eight HPF2 states. In addition, through the Ministry of Health’s Pharmaceutical Technical Working Group, USAID works with other stakeholders to ensure a coordinated and effective response to essential drug needs throughout the country.

• However, the needs remain much greater than the available resources, and donors alone cannot fully fund essential medicines for South Sudan.

USAID responses to inaccuracies in the article:

The article makes various claims (below) about the EMF expiring with “no mechanism set up to replace it”:

• “…by the time the EMF’s second round expired at the end of June 2015, the government still was not ready…Still, the EMF was allowed to expire with no mechanism set up to replace it. The result has been widespread shortages of basic drugs and supplies throughout the country.”

USAID response: The last round of EMF drug distribution to the seven stable states was completed in February 2016, with supplies expected to last through April 2016. Due to issues of insecurity, the final distribution to Jonglei, Upper Nile, and Unity states was not completed until March 2016. EMF officially closed in March 2016, with plans in place for follow-on support for procurement and distribution of essential medicines under the leadership of DFID, as described below.

As DFID has clarified, in order to avoid shortages of essential medicines in 2016, DFID used its HPF resources to support the six-month supply of essential medicines for South Sudan. The supplies, which began to arrive from late March, will last until August 2016. Following this, the HPF will be extended to March 2018 and will distribute the same essential medicines and commodities to eight of the ten states in South Sudan. A World Bank-led project will fund the two remaining states.

The article highlights particular shortages of essential medicines in Jonglei and Upper Nile:

• “Dr. Mounir Lado heads IMA World Health in South Sudan, which supports distribution of essential medicines in Jonglei and Upper Nile, two of the states worst-affected by the fighting. He said by the time the last round of medicines provided by the EMF expired in October 2015, ‘most of the health facilities have run out of stock and some have closed.’”

USAID response: The distribution of EMF quarter 3 and 4 supplies to Jonglei, Upper Nile, and Unity states was delayed for a long time due to inaccessibility and insecurity in the region. The final deliveries to these states were completed in March 2016. However, the recurrent conflict has negatively impacted many health facilities in the region.

The article highlights the lack of a system to track drug shortages in country:

“It is impossible to get a read on just how dire the situation is, because there is no functioning system in place to track drug shortages in South Sudan. Simon Mansfield, the head of office for ECHO – the European Commission’s humanitarian aid wing – said one of the main priorities right now is simply ‘trying to get a better idea of what are the essential gaps and what do we need to do to address them.’”

USAID response: The Ministry of Health, with support from USAID, the World Health Organization, and other partners, has established a pharmaceutical and supply chain management system in country, which has been operational since 2011. Key components of this system include:

• A functioning Pharmaceutical Technical Working Group, encompassing key national disease programs (e.g., malaria, tuberculosis, HIV/AIDS, family planning, etc), coordinates forecasting, quantification, and distribution of essential drugs and other medical supplies among all relevant stakeholders.

• The Logistics Management Unit manages a database on drug stocks reported from various states and counties. The unit receives reports from the field on a monthly basis, analyzes them, and presents data on essential drug stock levels and any stock outs to the Pharmaceutical Technical Working Group for decision making.

While much progress has been made in improving coordination and management of essential medicines, the pharmaceutical and supply chain system is still weak and requires continuous support to strengthen both the human resources and institutional capacity at all levels. This support is a continuing priority of USAID and many other donors.

The article questions HPF2’s prioritization of essential medicines:

• “Even now, more than a half a year after the EMF expired and with CAIPA’s six-month mandate set to come to an end, there is still no clear answer as to how essential medicines will be procured going forward…After the CAIPA arrangement ends in August, HPF-2 is scheduled to take over delivery of essential medicines in the eight states where it works…This proposal has Vuylsteke and others worried, not least because HPF-2’s goals – including health system strengthening and increased access to nutrition services – are much more diverse than the singularly focused EMF. There is concern that procurement and distribution of essential medicines may not be prioritized.”

USAID response: As described above, there are clear plans for HPF2 to support the procurement and distribution of essential medicines. Although HPF2 is a multi-faceted program, essential medicines are a priority for both HPF2 donors and the Ministry of Health. Procurement and distribution of essential medicines is managed by a separate fund manager than the service delivery and health systems strengthening components of HPF2, which ensures appropriate focus on this key priority. USAID will also continue to procure malaria commodities, in coordination with HPF2, to fill gaps as necessary.

Response to 'Why South Sudan's HIV epidemic is set to worsen'

Overview of U.S. Government support:

The U.S. Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), is committed to supporting comprehensive HIV prevention, care, and treatment services in South Sudan, in line with global goals to end the HIV epidemic by 2030. In FY 2017, PEPFAR—through USAID, the U.S. Centers for Disease Control and Prevention, and the U.S. Department of Defense—will invest more than $24.5 million in support of the HIV response in South Sudan. Through this support, more than 34,000 HIV-positive patients will be able to access lifesaving HIV treatment. In addition, in the coming year, PEPFAR will begin to support HIV services within the Juba Protection of Civilians site and military cantonments, and will also support the rollout of the country’s first AIDS Indicator Survey.

File photo: A protection camp in Unity State, South Sudan (Radio Tamazuj)