Building health care in hard to reach areas

In South Sudan, where only one in four people have access to medical facilities, virtually everyone qualifies as ‘hard to reach’. But Merlin is there, building lasting healthcare in the most isolated areas.

Decades of war and a lack of development have left the majority of South Sudan’s population without access to any form of healthcare. Expanding that access brings serious challenges, and Merlin meets them every day.

Cut off for eight months a year

Collins Kyererezi, Merlin’s primary healthcare supervisor in the isolated, mountainous Boma District said, "We are working in one of the most difficult environments in one of the most challenging countries in the world. Instead of expecting people to come to us, we reach out to them to give vaccinations, health education, primary health care and referrals."

"From April to December the rains set in, with virtually no road access to any of the locations we are serving outside of the town. Maintaining logistical support for the clinics is virtually impossible during the rains, so everything needs to be stockpiled in advance."

Only one of the four primary health units Kyererezi supervises is less than a day's walk from the Merlin hospital in Boma. Anyone requiring hospital treatment during the rains has to be carried on foot.

Many people in Boma are nomadic pastoralists, making it hard for them to get regular healthcare. And security is major a concern. In Jonglei State, violent clashes between various ethnic groups is common.

"For me personally, my greatest concern is supervising the clinics during the wet season due to inaccessibility and banditry - sometimes it is unsafe to walk without escort," Kyererezi said.

Lasting health care where no-one else goes

Merlin is the only healthcare provider in Boma. We work with a team of home-based hygiene promoters who, in addition to providing the population with basic health education and first aid, screen children under age five for malnutrition and refer complex pregnancies to Boma's basic hospital.

Low literacy rates in Boma make it difficult to recruit local staff, and qualified staff from other parts of the country view Boma as a tough place to work. To build lasting, self-sufficient healthcare Merlin trains people from the area, including those with rudimentary English-language skills. We provide a two-week crash course in how to manage childhood illnesses, immunization services, and maternal and child healthcare.

This approach has seen about 75 percent of children under five in Boma being reached in routine house-to-house vaccination campaigns, well above the national average of 37 percent. With village health workers able to screen for pregnancy complications, about 25 percent of deliveries now take place at Boma Hospital, an improvement over past rates in a country where, nationally, 90 percent of women in South Sudan give birth away from formal medical facilities and without the help of professionally trained assistants.