A Communal Approach to Battling Malaria in South Sudan

Patients start lining up as malaria agent Abraham prepares to start the test and treat activity for the day in the village of Maibong.
Alexandra Malm/MSF
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As case numbers continue to rise dramatically, it's become painfully clear that South Sudan's Abyei Special Administrative Area is in the midst of an exceptionally severe malaria season. But in an region where there are few health facilities to be found, many people afflicted with the disease are dying invisible deaths in their villages, before any assistance can reach them.

Doctors Without Borders/Médecins Sans Frontières (MSF) is working with local communities to put an end to preventable illness and deaths, with a community-based test-and-treat program that provides early malaria treatment for people living in distant rural areas.

Bringing Treatment to Patients

MSF has set up a network of 37 “malaria agents” supervised by six community health workers to diagnose and treat malaria in 23 villages within a 30-kilometer (20 mile) radius of the town of Agok. The teams use motorbikes to reach the villages, since the region’s poor roads are impassible to cars during the rainy season.

Since the start of the program in August, 19,411 people have received treatment in their villages after testing positive for malaria—an average of around 1,800 people per week. More than 160 of these cases were severe malaria, and were referred to MSF’s hospital in Agok for specialized treatment.

“Receiving treatment in their villages has been a game changer for people who before had to walk for several hours, and sometimes days, to get to the nearest health facility,” says MSF’s Jessa Pontevedra, who is managing the program. “It has allowed us to treat many more people than we had expected, and it has also significantly reduced the numbers of cases of severe malaria, as people are being treated earlier.”

A Reduction in Severe Cases

Earlier this year, MSF’s hospital was struggling to cope with the high numbers of patients admitted with severe malaria. “In June, we increased the number of beds from 125 to almost 200,” says MSF doctor Sabine Haller. “We put beds in the hallway, in the surgical ward, and in four tents in the courtyard, but the hospital was still overflowing with severe malaria patients.” But since the start of MSF’s community-based program, the percentage of severe cases has decreased, falling to 17 percent in September and October, compared to 23 percent at the same time last year.

Local communities have welcomed the new program, and their active involvement has been key to its success. “This has helped us a lot,” says Kuol Deng, leader of Mijak Deng Kaya village. “Last year, we had to carry a lot of sick people to the hospital, and many of them died.”

Community leaders relay information to the villagers, help store the medication and equipment, and have built shelters where the malaria agents can carry out their work. Sometimes they also provide financial compensation or incentives to the malaria agents, who work on a purely voluntary basis.

The malaria agents take great pride in their work and say they can really see the difference it is making to their communities.

“People get treatment now, but last year there were many deaths, as people couldn’t go all the way to the hospital,” says Abraham, a malaria agent who lives and works in the village of Maibong. “Seeing all these deaths was terrible. This is why I wanted to help my community—so that fewer people would die.”

MSF has been working in the region that today constitutes the Republic of South Sudan since 1983, and currently runs 17 projects in the country. MSF employs more than 3,200 South Sudanese staff to work alongside 350 international staff in its projects. In 2014, MSF teams provided more than 930,000 health consultations, providing free, high-quality medical care. Nearly 300,000 of these consultations were for children under the age of five.

Patients start lining up as malaria agent Abraham prepares to start the test and treat activity for the day in the village of Maibong.
Alexandra Malm/MSF