Increasing DPT3 vaccinations in post-conflict South Sudan

Background: The USAID-funded Sudan Health Transformation Project, second phase (SHTP II) began in 2009. The project implements a Basic Package of Health Services (BPHS) in 14 counties in South Sudan covering 1.4 million people through performance-based contracts (PBC) to 9 sub-contracting partners (SCPs). A 2006 household survey estimated coverage of the third dose of the diphtheria, pertussis and tetanus vaccine (DPT3) for < one year olds as 24%. Methods: SHTP II works to improve the capacity of the Government of South Sudan to manage health services, stressing community outreach, and improving access to fixed facilities. At the start of SHTP II, the MOH relied primarily on National Immunization Days to increase immunization coverage and the majority of vaccinations were delivered through campaigns, an unsustainable long term solution that misses large portions of the population. Beginning in FY10, SCPs began using a revised PBC scorecard that linked indicators, including DPT3 vaccinations, to payment. Results: Over a three-year period, DPT3 coverage increased to 70% of < ones in supported counties. DPT3 coverage doubled in a year after implementing the new PBC scorecard (from 30% to 70%). This successful immunization effort resulted from improvements in cold chain and vaccine supplies, community mobilization around the need for early childhood vaccinations, training of facility and community staff, improvements in infrastructure, and improved supervision of facilities and staff. Conclusion: In a challenging post-conflict environment like South Sudan, PBCs can support accelerated achievement of DPT3 coverage for children under one year of age.