Political will: necessary but not sufficient for control of an outbreak of acute watery diarrhoea in the Sudan, 2016-2018

Abstract

Background: During the period between August 2016 and April 2018, an outbreak of Acute Watery Diarrhea (AWD) spread all over the Sudan. The aim of this paper is to assess the role of political will of the government in institution of control measures. Methods: A total of 269 high-level decision-makers in the country were interviewed using detailed, adapted standardized tools with open-ended questions. Interviewees including selected Federal and five state Ministers of Health, parliamentarians, Country Representatives for selected UN agencies, senior officials in the government, media were conducted. Furthermore, many Focus Group Discussion (FGD) among others with healthcare workers, community groups, and partner organizations were held. Issues discussed during the interviews and focus group discussions included in-depth review of thematic and cross-cutting intervention areas; e.g., surveillance, case management, environmental health, health promotion, resource mobilization including funding, supplies and logistics; coordination and leadership in outbreak response. Results: High-level officials made containment of the outbreak a top priority, paid field visits to the affected areas, mobilized resources, closely provided sound stewardship for inter-sectoral activities and nurtured a collaborative environment for different stakeholders. The Humanitarian Aid Commission facilitated the activities of registered national and international NGOs and their international staff movement in the country, permitted easy and unlimited access to 92% of the country to ensure the safety of the international staff. Indicators reflected high political will of the government to respond to the AWD to its best ability. Yet, the outbreak continued for almost two years. Donors and UN agencies demonstrated flexibility to support response activities as they reprogrammed some ongoing activities to secure funds. Discussion: Inadequate transparency, primarily related to difficulties in sharing results of laboratory investigations during the AWD outbreak constrained and limited the potential benefits from partners. The Government needs to foster stronger coordination between water and health sectors; and explore information sharing portals e.g. website and Epi-bulletin; with partners. Partners and the government should jointly clarify their mandates and map their roles during outbreaks so as to avoid duplication, competition, and delays in response. Conclusion: Political will is a high level enabler which is necessary but not sufficient for control the AWD outbreak. "Health in All Policies" initiative offers a platform to address observed gaps both in financing of outbreak response and addressing underlying root causes for AWD outbreak.